预防儿童保健家庭访视“共同起步”应用程序的设计与评估

Design and evaluation of the StartingTogether App for home visits in preventive child health care.

作者信息

Blanson Henkemans Olivier Anne, Keij Marjolein, Grootjen Marc, Kamphuis Mascha, Dijkshoorn Anna

机构信息

1TNO, Child Health, Schipholweg 77-89, 2316 ZL, Leiden, The Netherlands.

Pharos, Arthur van Schendelstraat 620, 3511 MJ Utrecht, The Netherlands.

出版信息

BMC Nurs. 2018 Sep 15;17:41. doi: 10.1186/s12912-018-0310-2. eCollection 2018.

DOI:10.1186/s12912-018-0310-2

PMID:30237751

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6139149/

Abstract

BACKGROUND

The StartingTogether program (in Dutch SamenStarten) is a family-centred method for early identification of social-emotional and behavioural problems in young children. Nurses in preventive child health care find it challenging to: determine family issues and need for care; provide education; refer to social services; increase parent empowerment. To mitigate these challenges, we developed and evaluated the StartingTogether App, offering nurses and parents conversational support, tailored education and information on social services.

METHODS

A mixed method design, consisting of a qualitative evaluation of the StartingTogether App, with group discussions with nurses ( = 14) and a pilot test ( = 5), and a randomized controlled trial, evaluating the effectiveness of the app. Nurses ( = 33) made home visits to parents ( = 194), in teams with or without the app. Nurses were surveyed on the challenges experienced during visits. Parents ( = 166) were surveyed on their satisfaction with health care and app. Nurses were interviewed on the benefits and barriers to use the app.

RESULTS

Parents with the StartingTogether App were more satisfied with the visits than parents without ( = .002). Parents with a high educational level were more satisfied with the visits than the parents with a low educational level. With the app, their satisfaction level was similar ( < .001). Nurses using the app felt more equipped to communicate with parents ( = .012) and experienced that parents were more knowledgeable and skilled ( = .001). Parents felt that with the app the nurse was more polite ( = .02), listened more carefully ( = .03), and had more time ( = .02). Nurses with the app gave parents more opportunity to ask questions ( = .001) and gave clearer answers ( < .001). The qualitative evaluation indicated that some nurses needed extra time to develop the habit of using the app.

CONCLUSIONS

The StartingTogether App contributes to parents' satisfaction with home visits. An interaction effect between parents' educational level and rating of home visits indicated that the app has an additional value for parents with a lower educational level. Applying mobile applications, such as the StartingTogether App, potentially has a positive effect on communication between nurses and parents about the family situation in relation to parent empowerment and the child's development.

TRIAL REGISTRATION

The study is registered with ISRCTN under the number ISRCTN12491485, on August 23, 2018. Retrospectively registered.

摘要

背景

“共同起步”项目（荷兰语为SamenStarten）是一种以家庭为中心的方法，用于早期识别幼儿的社会情感和行为问题。儿童预防保健护士发现，在以下方面颇具挑战：确定家庭问题和护理需求；提供教育；转介至社会服务机构；增强家长权能。为应对这些挑战，我们开发并评估了“共同起步”应用程序，为护士和家长提供对话支持、量身定制的教育内容以及有关社会服务的信息。

方法

采用混合方法设计，包括对“共同起步”应用程序进行定性评估，与护士进行小组讨论（n = 14）和进行试点测试（n = 5），以及一项随机对照试验，评估该应用程序的有效性。护士（n = 33）分组对家长（n = 194）进行家访，一组使用该应用程序，另一组不使用。对护士在家访过程中遇到的挑战进行调查。对家长（n = 166）对医疗保健和应用程序的满意度进行调查。就使用该应用程序的益处和障碍对护士进行访谈。

结果

使用“共同起步”应用程序的家长对家访的满意度高于未使用的家长（P = 0.002）。高学历家长对家访的满意度高于低学历家长。使用该应用程序后，他们的满意度水平相似（P < 0.001）。使用该应用程序的护士感觉在与家长沟通方面更有能力（P = 0.012），并体验到家长更有知识和技能（P = 0.001）。家长认为使用该应用程序后，护士更有礼貌（P = 0.02）、听得更仔细（P = 0.03）且有更多时间（P = 0.02）。使用该应用程序的护士给家长更多提问机会（P = 0.001），并给出更清晰的答案（P < 0.001）。定性评估表明，一些护士需要额外时间来养成使用该应用程序的习惯。