Identifying and developing strategies for implementation of a guided internet- and mobile-based infant sleep intervention in well-baby and community mental health clinics using group concept mapping.

BACKGROUND: This study aimed to identify strategies for the implementation of a guided internet- and mobile-based intervention (IMI) for infant sleep problems ("Sleep Well, Little Sweetheart") in well-baby and community mental health clinics. STUDY DESIGN: We used group concept mapping, a two-phased mixed methods approach, conducted as a two-day workshop in each clinic. We recruited 20 participants from four clinics and collected sorting and rating data for implementation strategies based on the Expert Recommendations for Implementing Change taxonomy and brainstorming sessions. Data were analyzed using descriptive statistics, multidimensional scaling, and hierarchical cluster analysis to create cluster maps, laddergrams, and Go-Zone graphs. Participants were presented with the results and discussed and interpreted the findings at each of the clinics in spring 2022. RESULTS: Participants identified 10 clusters of strategies, of which Training, Embedding and Coherence, User Involvement and Participation, and Clinician Support and Implementation Counseling were rated as most important and feasible. Economy and Funding and Interactive and Interdisciplinary Collaboration were rated significantly lower on importance and feasibility compared to many of the clusters (all ps < 0.05). There was a correlation between the importance and feasibility ratings (r =.62, p =.004). CONCLUSIONS: The use of group concept mapping made it possible to efficiently examine well-baby and community clinics' perspectives on complex issues, and to acquire specific knowledge to allow for the planning and prioritization of strategies for implementation. These results suggest areas of priority for the implementation of IMIs related to infant sleep problems. TRIAL REGISTRATION: The study was pre-registered at Open Science Framework ( www.osf.io/emct8 ).

The effect of relationship-based interventions for maltreated children and adolescents: a systematic review and meta-analysis.

Child maltreatment is characterized by a harmful relational environment which can have negative cascading consequences for the child's development. Relationship-based interventions may improve maltreated children's functioning by addressing key aspects of the parent-child relationship at various stages of development. The objective of the current study was to perform a systematic review on relationship-based interventions for maltreated children and a meta-analysis on the impact of these interventions on observed parent-child relational behavior. Data collection consisted of a comprehensive literature search in six databases and contacting experts in the field and hand searching relevant publications. In total, 5,802 abstracts were screened, of which 81 relevant publications were identified, representing 4,526 participants. The meta-analysis found large improvements in observed parent interactive behavior (g = 0.888), smaller improvements in child attachment (g = 0.403) and child interactive behavior (g = 0.274). The effect on parent interactive behavior was larger in interventions addressing middle childhood. Risk of bias assessments showed that a large number of studies suffer from poor reporting, which limits the conclusions of the findings. Future research should examine parent-child relationship behavior across multiple developmental stages, as well as the impact of developmentally appropriate intervention elements on maltreated children.

Internet-based interventions for parents with children 0-5 years: A scoping review.

AIM: This study aims to review the existing literature on Internet-based health interventions directed to support parents of children aged 0-5 years. METHODS: We systematically searched electronic databases between January 2000 and 2018. The search consisted of terms describing eHealth, intervention and families and/or children. RESULTS: Internet-based parent support interventions were most often directed at rehabilitation and selective prevention, and we identified more studies on mental health (57%) than somatic health (41%). Developmental disorders were the most frequently studied mental health condition (n = 33), while interventions for obesity (15%) were the most studied somatic health condition. Forty-four percent of mental health studies were RCTs and 65% of interventions were theory driven. Interventions most often used a behavioural approach, included guidance and delivered content via text-based information. CONCLUSION: Several significant gaps were identified such as the need for more research outside of English-speaking countries, more systematic reviews and effect studies. This review also elucidates the need for researchers to improve reporting on the theoretical approaches employed in interventions, and to focus on determining the importance of guidance. Finally, program developers should consider using more audio-visual technology to avoid reinforcing social inequalities in access to healthcare.

To see or not to see - or to wait and see: clinical decisions in an oncological emergency telephone consultation.

BACKGROUND: Cancer treatment is often given on an outpatient basis. An oncological emergency telephone line has been established to improve access to cancer care and prevent life-threatening side effects. However, healthcare professionals need to make clinical decisions without being able to assess patients face-to-face, which may be problematic. This study explores how healthcare professionals experience clinical decision-making in oncological emergency telephone consultations. METHODS: An exploratory qualitative approach applying three focus groups with healthcare professionals from a Danish university hospital were undertaken. Data were analysed using inductive content analysis. RESULTS: An overall theme elucidated how healthcare professionals ended up deciding during each call whether the problem could be solved on the phone or the patient had to come for a face-to-face consultation or to wait and see whether the condition changed. Some decisions were easy to make, while others were moderate or difficult. The decision was influenced by several factors that could be structured into three themes: reliance on one's own knowledge and experience, consideration of different perspectives and the influence of context. CONCLUSION: This study demonstrated that clinical decision-making in oncological emergency telephone consultations includes three types of decisions that are intertwined with intra-personal, inter-professional and contextual factors such as personal knowledge, collaboration and workload. These factors are essential for the timely referral of patients to the right level of service.

Calling an Oncological Emergency Telephone to Seek Advice: An Interview Study.

BACKGROUND: Cancer treatment is increasingly provided on an outpatient basis, which may challenge patients and caregivers coping with illness and adverse effects at home. A telephone consultation is an accepted type of healthcare provision to support patients and prevent adverse outcomes when their capacity to self-manage is inadequate. Whether this option for help sufficiently supports patients needs further investigation. OBJECTIVES: The aim of this study was to explore patients' and caregivers' experience of calling an oncological emergency telephone. METHODS: The study applies a phenomenological hermeneutic approach with 12 semistructured interviews. Patients and caregivers who had called the oncological emergency telephone within the last 2 months were included. The interview texts were analyzed by content analysis. RESULTS: Patients and caregivers perceive the emergency telephone as a lifeline that they consider calling when the patient's condition changes from what they understand as normal to what they perceive as abnormal. They would rather call "one time too many than one time too few" if their resources are inadequate to ensure their safety. The tone, attitude, and professional competency of healthcare providers affect patients' experience of the call. CONCLUSIONS: The value of calling the oncological emergency telephone depends on the healthcare providers' professional competences and skills to establish a relationship that makes patients feeling accommodated and taken care of. IMPLICATIONS FOR PRACTICE: Patients' and caregivers' perceptions of what constitutes a good telephone consultation represent significant knowledge that contributes to a more comprehensive and practice-based understanding of what is required to advise patients and caregivers in an oncological emergency telephone.

Managing the absent clinical eye in calls to an oncological emergency telephone - a focus group study.

BACKGROUND: Telephone consultations are common in supporting patients and caregivers in managing symptoms from cancer diseases and side effects from cancer treatment. In connection with telephone consultations, it may be a challenge that healthcare professionals have to rely on their auditory sense alone when they assess whether the problem can be solved over the telephone, or whether patients need an examination face to face. OBJECTIVE: To explore how healthcare professionals identify patients' essential concerns and assess serious conditions in calls to an oncological emergency telephone without face-to-face contact. METHODS: From a phenomenological-hermeneutical frame of reference, the analysis of three focus groups with a total of 16 healthcare professionals was guided by content analysis. ETHICS: The study follows the ethical guidelines for research. RESULTS: Two themes emerged. To identify patients in serious conditions, healthcare professionals kept focus on: (1) 'Reaching a mutual understanding without the clinical eye'. Before making a decision regarding a face-to-face examination, the healthcare providers were as follows: (2) 'Listening to an inner voice - attention on clues and signs'. LIMITATIONS: The transferability of the findings is limited to healthcare professionals who perform telephone-mediated care in a team of nurses and physicians. CONCLUSION: Staying open for diverse perspectives and integrating nonanalytical as well as analytical illness scripts, healthcare professionals were able to identify patients that needed further examination face to face.

The role of responsibility in oncological emergency telephone calls.

BACKGROUND: Patients and their caregivers are expected to take joint responsibility for reporting symptoms and seeking medical assistance, for example, by calling oncology emergency telephones or other helplines during a cancer trajectory. RESEARCH OBJECTIVE: The aim was to explore the meaning of responsibility as it appeared in patients' or caregivers' experiences of calling an oncological emergency telephone. DESIGN, PARTICIPANTS AND CONTEXT: Inspired by qualitative description and qualitative content analysis, a secondary analysis of data from interviews with 12 participants calling the oncological emergency telephone at a Danish university hospital was performed. ETHICAL CONSIDERATIONS: The project observes demands for safekeeping data and all regulations concerning research ethics in agreement with the Nordic Nurses Federation and the Danish Health Act. FINDINGS: Two main themes emerged: (1) to act responsibly as a patient or caregiver was to 'be watchful and alert', 'report symptoms the right way' and 'do crosschecking' and (2) to deal with the burden of responsibility was to 'feel safe when dealing with the burden of responsibility' and 'be relieved from the burden of responsibility'. DISCUSSION: Too much responsibility and a potential imbalance between healthcare professionals' expectations and callers' knowledge and capacity to act may place additional burdens on the callers, which may be eased by person-centred care. CONCLUSION: The meaning of responsibility appeared in the participants' capacity to act, where they observed, assessed and reported symptoms and controlled prescribed treatments as well as shared or handed over the responsibility to the healthcare providers. Thus, the analysis provided essential knowledge for healthcare professionals on how patients and caregivers handle this responsibility when faced with a cancer disease that is treated on an outpatient basis.

Quality of social interaction in foster dyads at child age 2 and 3 years.

The main aim of this study was to investigate the quality of social interaction between 60 foster parents and their foster children compared to a group of 55 non-foster families at 2 (T1) and again at 3 (T2) years of age. Video observations were used to investigate child-parent interaction at both time-points. "This is My Baby" interview was administered to investigate foster parents' commitment at T1. The main results revealed significant group differences at T1 on all child-parent social interaction measures, although not at T2. Further, a significant group by time interaction was identified for parental sensitivity, revealing a positive development over time in the foster group. Finally, a significant positive relation was found between commitment at T1 and parental sensitivity. The results convey an optimistic view of the possibilities for foster dyads to develop positive patterns of social interaction over time.

The relation of dissociation and mind wandering to unresolved/disorganized attachment: an experience sampling study.

Individuals with unresolved/disorganized representations of childhood trauma (U/d attachment) report more psychological distress than others, but little is known about their everyday mentation. In the present study adults with childhood trauma (N = 45) completed the Berkeley-Leiden Adult Attachment Questionnaire-Unresolved (BLAAQ-U) and the Adult Attachment Interview (AAI), and reported everyday mentation during 5 days of experience sampling. The BLAAQ-U and the AAI showed a medium association with each other, but only the former significantly predicted negative affect, dissociation, and low control/awareness of mentation. Contrary to our predictions, U/d attachment did not significantly predict mind wandering, but the BLAAQ-U predicted endorsements of a negative mind wandering style. U/d attachment, as assessed by both instruments, was associated with the Poor attentional control style and beliefs in anomalous mental phenomena. Experience sampling is a valuable way to investigate everyday experiences in individuals with U/d attachment.

[Young Foster Children's Attachment and Socio-emotional Functioning - A Norwegian Prospective and Longitudinal Study]. / Bindung und sozio-emotionale Fähigkeiten von jungen Pflegekindern - eine norwegische prospektive Längsschnittstudie.

The main aim of the present study was to investigate 60 young foster children's attachment to their foster parents and their socio-emotional functioning at age two and three years compared to 42 low-risk children. At age two, the children were seen in the Strange Situation Procedure (SSP), and a foster parental report was used to investigate socio-emotional functioning. A majority of the foster children was classified as securely attached at both time points, and no significant group difference was detected. Furthermore, among those who were securely attached at age of two, a large majority remained so one year later. Concerning social-emotional functioning, the foster children were reported to show more problem behaviour and less competence at age two and three, although their scores were within age-related norms. The results in the present study are optimistic. However, the question is whether such a positive developmental pathway will last when the foster children will meet new challenges such as school entry and establishing close peer relationships.

Attachment security in young foster children: continuity from 2 to 3 years of age.

The present study investigated attachment patterns among 60 foster children (FC) and 42 comparison children (CC) at 2 years (T1) and again at 3 years (T2) of age, as well as stability from T1 to T2. Descriptive analyses, including cross-tabulation, were used to present attachment patterns, group differences and stability from T1 to T2. Most FC were securely attached at T1, and no group differences were identified; neither the FC nor CC differed from typical children in their attachment patterns. Furthermore, the majority of children in both groups received the same classification at both time points. Among FC who were securely attached at T1, a majority remained so at T2, while among those classified as disorganized at T1, significantly less remained so at T2. The study suggests that young FC have the possibility to form enduring secure attachments when placed in stable and well-functioning foster homes.

Foster parents' state of mind with respect to attachment: concordance with their foster children's attachment patterns at 2 and 3 years of age.

The present study investigated the possible differences between foster and comparison parents' state of mind with respect to attachment, and the concordance between caregiver state of mind and child attachment classifications among 60 foster children, all placed before the age of 2 years, as well as 42 comparison children. Caregiver state of mind was measured when the children were 2 years old (Time 1) while child attachment classifications were assessed at age 2 and again at age 3 years (Time 2). The associations between foster children's attachment, age at first and final placements, number of placements, and reasons for placement also were investigated. Descriptive analyses, including cross-tabulations, and independent sample t tests were used. The results showed that the majority of the foster parents had an autonomous state of mind, and no significant group difference between foster and comparison parents was identified. At both time points, most foster children who were classified as secure had autonomous foster parents, as also was the case for the comparison children. The present results are encouraging, suggesting that placing foster children with autonomous foster parents early in life may help them to remain secure over time. Furthermore, focusing on the recruitment of autonomous foster parents is important when working with young foster children.

Cognitive development and social-emotional functioning in young foster children: a follow-up study from 2 to 3 years of age.

Foster children (FC) are at risk of delayed development relative to their peers due to early caregiver disruptions and adverse experiences prior to placement. Descriptive analyses and linear mixed effects (LME models) were used to analyse the cognitive development and social-emotional functioning of 60 FC and 42 comparison children (CC) at 2 (T1) and 3 years (T2). Changes in group differences between T1 and T2 were examined, and significant group differences occurred on all cognitive scales, with the FC obtaining lower scores than the CC. An analysis of social-emotional functioning revealed significantly more externalising, dysregulation behaviour and poorer competencies among the FC, which exhibited significantly better cognitive abilities and competencies at T2 than T1, with the exception of receptive language. The FC did not demonstrate more negative social-emotional behaviour at T2 (apart from more internalisation behaviour), but failed to catch up with the CC. Young foster children need screening and support to improve their developmental potential.

A tele-obstetric broadband service including ultrasound, videoconferencing and cardiotocogram. A high cost and a low volume of patients.

We established a tele-obstetric service connecting the Department of Obstetrics and Gynaecology at the Nordland Hospital in Bodø to the delivery unit at the Nordland Hospital in Lofoten. The telemedicine service included a videoconferencing link (3 Mbit/s) for transmission of ultrasound scans and a low-speed data link (telephone modem) for transmission of cardiotocograms (CTGs). One hundred and thirty pregnant women entered the antenatal clinic in Lofoten during the eight-month study period. A total of 140 CTGs were recorded. The tele-ultrasound service was used in five cases (4%). The cases were serious malformation, Down's syndrome, breech presentation, vaginal bleeding during pregnancy and triplets. Analysis showed that the cost of patient travel was NOK 2460 per transfer. The variable cost of videoconferencing was NOK 250 per consultation. However, the total investment costs for the telemedicine service, including the broadband infrastructure, was NOK 1.7 million (Euro 212,000). The telemedicine service was not cost saving at annual workloads below 208. We conclude that the installation has to be used by other medical specialities to make it cost-effective.