Garg Pankaj, Ha My Trinh, Eastwood John, Harvey Susan, Woolfenden Sue, Murphy Elisabeth, Dissanayake Cheryl, Williams Katrina, Jalaludin Bin, McKenzie Anne, Einfeld Stewart, Silove Natalie, Short Kate, Eapen Valsamma
Department of Community Paediatrics, Liverpool Hospital, Liverpool, NSW, Australia.
School of Women's and Children's Health, UNSW, Sydney, Australia.
BMC Fam Pract. 2018 Apr 2;19(1):42. doi: 10.1186/s12875-018-0728-3.
Encouraging early child development and the early identification of developmental difficulties is a priority. The Ministry of Health in the Australian State of New South Wales (NSW), has recommended a program of developmental surveillance using validated screening questionnaires, namely, the Parents' Evaluation of Development Status (PEDS) and Ages and Stages Questionnaire (ASQs), however, the use of these tools has remained sub-optimal. A longitudinal prospective birth cohort "Watch Me grow" study was carried out in the South Western Sydney (SW) region of NSW to ascertain the uptake as well as the strategies and the resources required to maximise engagement in the surveillance program. This paper reports on a qualitative component of the study examining the attitudes, enablers and barriers to the current developmental surveillance practices, with reference to screening tools, amongst health professionals.
Qualitative data from 37 primary health care providers in a region of relative disadvantage in Sydney was analysed.
The major themes that emerged from the data were the "difficulties/problems" and "positives/benefits" of surveillance in general, and "specificity" of the tools which were employed. Barriers of time, tool awareness, knowledge and access of referral pathways, and services were important for the physician providers, while the choice of screening tools and access to these tools in other languages were raised as important issues by Child and Family Health Nurses (CFHN). The use of these tools by health professionals was also influenced by what the professionals perceived as the parents' understanding of their child's development. While the PEDS and ASQs was utilised by CFHNs, both General Practitioners (GPs) and paediatricians commented that they lacked awareness of developmental screening tools and highlighted further training needs.
The results highlight the practical challenges to, and limited knowledge and uptake of, the use of recommended screening tools as part of developmental surveillance. There is a need for further research regarding the most effective integrated models of care which will allow for a better collaboration between parents and service providers and improve information sharing between different professionals such as CFHNs GPs, Practices nurses and Paediatricians involved in screening and surveillance programs.
鼓励儿童早期发展并尽早识别发育困难是一项优先事项。澳大利亚新南威尔士州（NSW）卫生部推荐了一项使用经过验证的筛查问卷进行发育监测的计划，即《父母发育状况评估》（PEDS）和《年龄与阶段问卷》（ASQs），然而，这些工具的使用情况仍未达到最佳状态。在新南威尔士州的悉尼西南部（SW）地区开展了一项纵向前瞻性出生队列“看我成长”研究，以确定监测计划的采用情况以及最大限度参与该计划所需的策略和资源。本文报告了该研究的一个定性部分，该部分研究了卫生专业人员对当前发育监测实践（涉及筛查工具）的态度、促进因素和障碍。
对悉尼一个相对贫困地区的37名初级卫生保健提供者的定性数据进行了分析。
数据中出现的主要主题是总体监测的“困难/问题”和“积极方面/益处”，以及所使用工具的“特异性”。时间、工具认知、转诊途径的知识和获取以及服务等障碍对医生提供者很重要，而儿童和家庭健康护士（CFHN）则提出筛查工具的选择以及以其他语言获取这些工具是重要问题。卫生专业人员对这些工具的使用还受到专业人员所认为的父母对其孩子发育的理解的影响。虽然CFHN使用了PEDS和ASQs，但全科医生（GP）和儿科医生都表示他们对发育筛查工具缺乏了解，并强调了进一步培训的需求。
结果凸显了将推荐的筛查工具用作发育监测一部分所面临的实际挑战、有限的知识水平和采用率。需要进一步研究最有效的综合护理模式，这将有助于父母与服务提供者之间更好地协作，并改善参与筛查和监测计划的不同专业人员（如CFHN、GP、执业护士和儿科医生）之间的信息共享。
