Facilitators and barriers when implementing a new clinical visit for fathers at Stockholm County child health centres: A qualitative study of nurse-managers at top-performing centres.

BACKGROUND: In 2017, a new clinical visit for non-birthing parents (e.g. fathers) of three-to-five month old infants was implemented in Stockholm County. In 2018, 19 out of 134 child health centres (CHCs) saw 62% of all fathers at the father visit and these CHCs had the highest fidelity scores. The aim of the current study was to assess nurse-managers' perceptions of facilitators and barriers to implementating the father visit. METHODOLOGY: Semi-structured interviews were conducted with nurse-managers from seven CHCs. Interviews were audio-recorded, transcribed and then analysed using systematic text condensation. Hasson's modified version of the Conceptual Framework for Implementation Fidelity was used to interpret the findings. RESULTS: Six themes emerged during the analysis, which were sorted into perceived facilitators and barriers regarding the implementation of the father visit. Facilitators included: 1) nurses are facilitators of change, 2) fathers are worthy of change, 3) a child has two parents and 4) effective cooperation. The barriers included: 5) money talks and 6) nurses under pressure. CONCLUSION: These findings provide insight into factors that moderated the implementation fidelity of the father visits at CHCs with some of the highest levels of father attendance. This provides a model of good practice that can be applied to other settings to maximise fidelity, as well as increase attendance at father visits. Findings also provide insight into the relationship between potential moderators and implementation fidelity.

Perceived barriers to care for migrant children and young people with mental health problems and/or neurodevelopmental differences in high-income countries: a meta-ethnography.

OBJECTIVES: To develop conceptual understanding of perceived barriers to seeking care for migrant children and young people (aged 0-25 years) with mental health problems and/or neurodevelopmental differences in high-income countries. DESIGN: Qualitative evidence synthesis using meta-ethnography methodology. We searched four electronic databases (Medline, PsycINFO, Global Health and Web of Science) from inception to July 2019 for qualitative studies exploring barriers to care (as perceived by migrant communities and service providers) for migrant children and young people in high-income countries with neurodevelopmental differences and/or mental health problems. The quality of included studies was explored systematically using a quality assessment tool. RESULTS: We screened 753 unique citations and 101 full texts, and 30 studies met our inclusion criteria. We developed 16 themes representing perceived barriers to care on the supply and demand side of the care-seeking process. Barriers included: stigma; fear and mistrust of services; lack of information on mental health and service providers lacking cultural responsiveness. Themes were incorporated into Levesque et al's conceptual framework of patient-centred access to healthcare, creating a version of the framework specific to migrant children and young people's mental health and neurodevelopmental differences. CONCLUSIONS: This is the first qualitative evidence synthesis on barriers to care for mental health problems and/or neurodevelopmental differences in migrant children and young people in high-income countries. We present an adapted conceptual framework that will help professionals and policy-makers to visualise the complex nature of barriers to care, and assist in improving practice and designing interventions to overcome them. Similar barriers were identified across study participants and migrant populations. While many barriers were also similar to those for children and young people in general populations, migrant families faced further, specific barriers to care. Interventions targeting multiple barriers may be required to ensure migrant families reach care.

Effect and process evaluation of a multicomponent public health intervention to increase the use of primary care-based mental health services amongst children with a migrant background in Stockholm, Sweden: a protocol for a mixed-methods study.

INTRODUCTION: The overall aim of the project is to understand how to increase access to, and use of, primary care-based mental health services for children and youth from a migrant background with mild to moderate mental health problems. METHODS AND ANALYSIS: The study will be undertaken in Haninge municipality in Stockholm, Sweden. The study has three intervention components: (1) A health communication intervention targeting parents of children/youth with a migrant background; (2) Training of professionals and volunteers who potentially have contact with parents and children with a migrant background, in order to increase the number of referrals to primary care-based mental health services, and (3) Increasing access to care at a primary care-based mental health service for children, using various strategies to lower barriers to care. The complex multicomponent intervention will be studied with an effect and a process evaluation methodology. ETHICS AND DISSEMINATION: All planned studied are approved by the Swedish Ethical Review Authority dnr 2017-135-31/5, 2019-06275, 2020-03640, 2020-06341, 2020-03642 and 2020-04180. Informed consent, written or verbal, will be obtained from all participants. The results of the project will be published continually in peer-reviewed scientific journals and disseminated to relevant stakeholders nationally and within Haninge municipality.

Interventions to increase migrants' care-seeking behaviour for stigmatised conditions: a scoping review.

BACKGROUND: Despite availability of effective treatments, migrants in high-income countries seek care for conditions associated with stigma to a lower extent than the rest of the population. We conducted a scoping review to map the literature on interventions to increase migrants' care-seeking behaviour in high-income countries for stigmatised conditions. Main body of the abstract: We searched 15 electronic databases and journals, hand-searched references and citations, to identify studies on interventions to increase migrants' care-seeking in high-income countries for stigmatised conditions. We applied language restrictions for English and Swedish, and searched the full time period up to 5 July 2019. Our primary outcome of interest was care utilisation. RESULTS: 5447 records were identified in the literature searches. We identified 16 eligible studies, all from North America, that reported interventions to increase migrants' care-seeking behaviour for hepatitis B (n = 1) and mental health (n = 15). Three approaches were identified: health communication (n = 10), support groups (n = 2), and primary care-based approaches (n = 4). There was a general trend towards community-based interventions tailored to individual migrant groups. Significant gaps were identified in the literature, including studies conducted in Europe and studies including men or children. Furthermore, the choice of study designs introduced significant bias that prevented accurate conclusions on intervention effectiveness. CONCLUSION: The available evidence on interventions to increase migrants' in high-income countries care-seeking behaviour for stigmatised conditions is limited in scope and quality. Future research, using reliable study designs, is needed to fill the remaining gaps and to boost the scope and reliability of the evidence.