Faculty of Health and Sports Sciences, University of Agder, P.O. Box 422, 4604, Kristiansand, Norway.
NORCE, Universitetsveien 19, 4630, Kristiansand, Norway.
BMC Health Serv Res. 2021 Jan 23;21(1):86. doi: 10.1186/s12913-021-06096-x.
An increased and/or stable proportion of the child and adolescent population reports symptoms of impaired health, and the symptoms can be identified early. Therefore, structured child- and parent-reported outcome measures need to be implemented in child and school health services for decision support and identification of children at risk. We aimed to (a) qualitatively examine adjustments of active implementation from the pilot implementation of the Norwegian 'Starting Right' health service innovation including an online child health assessment tool and practical routines, and (b) measure practitioners´ adoption and parental acceptability.
We used a mixed-methods design to qualitatively examine adjustments from working notes and meeting memoranda, and quantitatively assess adoption and acceptability from user rates provided by the systems log. Twenty-one child and school health nurses (CSHNs) from two child health centers participated in the implementation pilot of online health assessments in children aged 2-, 4- and 6-year. We used a deductive and narrative analysis approach using Fixsen et al.´s core implementation components to code and sort adjustments.
Core implementation components were adjusted throughout the pilot implementation. Researchers´ increased their availability in reciprocity with staff evaluation to integrate active implementation adjustments. We launched a project for improved data systems integration. The overall CSHNs adoption rate was satisfactory and higher in center A, where a medical secretary supported the nurses through the entire pilot phase, than in center B (96 vs. 55 %). Parental acceptability rate was overall high (77 %) with increased rates among parents of 6-year-old children (98 %) compared with younger ones (78-85 %), and in cases where both parents received the questionnaires.
The 'Starting Right' health service innovation implementation was actively adjusted by integration of core implementation components mainly based on staff evaluation. The CSHNs adopted the innovation which was also acceptable to parents.
越来越多的儿童和青少年群体报告出现健康受损症状，且这些症状能够被早期识别。因此，需要在儿童和学校卫生服务中引入针对儿童和家长的标准化评估工具，为决策提供支持并识别出高危儿童。本研究旨在：（一）定性研究从试点实施“从一开始就做正确”（Starting Right）卫生服务创新中获得的经验，包括在线儿童健康评估工具和实用程序；（二）测量从业者的采用情况和家长的接受程度。
我们采用混合方法设计，从工作笔记和会议记录中定性研究调整措施，从系统日志中提供的用户使用率定量评估采用率和接受度。21 名来自两个儿童健康中心的儿童和学校保健护士（CSHNs）参与了该研究，他们在 2 岁、4 岁和 6 岁儿童中试点实施在线健康评估。我们使用了 Fixsen 等人的核心实施要素的演绎和叙述分析方法对调整措施进行编码和分类。
在试点实施过程中，核心实施要素得到了调整。研究人员增加了可用性，以回应员工评估，从而整合了积极的实施调整。我们启动了一个改善数据系统集成的项目。总体上，CSHNs 的采用率令人满意，在有医疗秘书在整个试点阶段支持护士的中心 A 中更高（96% vs. 55%），而在中心 B 中则较低（55%）。家长的接受率总体较高（77%），6 岁儿童的家长接受率（98%）高于较小儿童（78-85%），且当父母双方都收到问卷时，接受率更高。
“从一开始就做正确”卫生服务创新的实施主要基于员工评估，通过整合核心实施要素进行了积极调整。CSHNs 采用了该创新，家长也接受了该创新。
