Burström Bo, Marttila Anneli, Kulane Asli, Lindberg Lene, Burström Kristina
Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, SE 171 77, Sweden.
Stockholm County Council Health Services, Stockholm, Sweden.
BMC Health Serv Res. 2017 Jan 28;17(1):91. doi: 10.1186/s12913-017-2038-1.
In spite of a well-developed welfare system in Sweden, there are important health divides between residential areas in Stockholm county, with shorter life expectancy in disadvantaged areas. These socioeconomic and health divides also affect children. Extra efforts and organized collaboration by different authorities are required to meet the greater needs of children growing up in these areas.
METHODS/DESIGN: This article reports on the programme logic and evaluation design of an extended postnatal home visiting programme in collaboration between child health services and social services in the Rinkeby area, Stockholm, Sweden, where a large proportion are recent immigrants and more than 50% are at-risk of poverty. The intervention consists of five extra home visits when the child is aged between 2-15 months, jointly by a child health nurse and a social service parental advisor, offered to all parents of first-born children attending Rinkeby child health centre. Parents of first-born children attending child health centres in neighboring areas serve as controls. The evaluation will use a mixed methods approach, including participant observation, in-depth interviews, interviews using structured questionnaires, review and analysis of child health records and records of health care utilization.
The intervention has so far been very positively received by the parents (95% participation rate), who seem to perceive that they actually benefit from participating, and also from staff in child health services and social services who find this approach to be in line with their professional intentions. The staff members interviewed also appreciate the inter-professional collaboration. The intervention has sparked activities also in other sectors (the local library, the open child day care centre) of the local area. The timing of the intervention, at the start of the child's life, may be well suited to support parents in reorienting themselves and finding a positive parenting role, to the benefit of the development of the child. The intervention may be seen as a concrete example of "proportionate universalism", as a strategy to reduce inequalities in health - applying a universal intervention with increased intensity in groups that have a greater need for it.
The study was retrospectively registered (11 August 2016) in the ISRCTN registry ( ISRCTN11832097 DOI: 10.1186/ISRCTN11832097 ).
尽管瑞典拥有完善的福利体系，但斯德哥尔摩郡各居民区之间仍存在显著的健康差异，贫困地区居民的预期寿命较短。这些社会经济和健康差异也影响着儿童。不同部门需要付出更多努力并开展有组织的合作，以满足在这些地区成长的儿童的更多需求。
方法/设计：本文报告了瑞典斯德哥尔摩林克比地区儿童健康服务机构与社会服务机构合作开展的一项扩展产后家访计划的项目逻辑和评估设计。该地区很大一部分是新移民，超过50%的人有贫困风险。干预措施包括在孩子2至15个月大时，由儿童健康护士和社会服务家长顾问共同进行五次额外的家访，对象是所有在林克比儿童健康中心就诊的头胎孩子的父母。在邻近地区儿童健康中心就诊的头胎孩子的父母作为对照。评估将采用混合方法，包括参与观察、深入访谈、使用结构化问卷进行访谈、查阅和分析儿童健康记录以及医疗保健利用记录。
到目前为止，该干预措施受到了家长的非常积极的欢迎（参与率为95%），他们似乎认为自己确实从参与中受益，儿童健康服务机构和社会服务机构的工作人员也认为这种方法符合他们的专业意图。接受采访的工作人员也赞赏这种跨专业合作。该干预措施还在当地的其他部门（当地图书馆、开放式儿童日托中心）引发了活动。在孩子生命开始时进行干预，可能非常适合支持父母重新定位自己并找到积极的育儿角色，从而有利于孩子的成长。该干预措施可以被视为“相称普遍主义”的一个具体例子，作为一种减少健康不平等的策略——对有更大需求的群体实施强度更大的普遍干预。
该研究于2016年8月11日在ISRCTN注册中心进行了回顾性注册（ISRCTN11832097 DOI: 10.1186/ISRCTN11832097）。
