Henström Maria, Delisle Nyström Christine, Andermo Susanne, Thomas Kristin, Löf Marie
Department of Medicine, Huddinge, Karolinska Institutet, Huddinge, 141 83, Sweden.
Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, 141 83, Huddinge, Sweden.
BMC Public Health. 2025 May 2;25(1):1637. doi: 10.1186/s12889-025-22786-1.
Early-life interventions are essential for improving public health since lifestyle behaviours are established already in childhood. Child healthcare (CHC) plays a crucial role in this context. The 'Saga Stories in health talk' (SSiHT) material includes a flipchart with colourful illustrations to facilitate CHC nurses' routine health talks with parents and their children, and a hand-out material kit to support healthy lifestyle behaviours in the families. Our aim was to evaluate the effectiveness of the SSiHT intervention at the 5-year routine visit at CHC on parental self-efficacy (primary outcome) and children's health-related behaviours (secondary outcomes). Implementation aspects for using the SSiHT material in routine practice for health talks at the 5-year visit were simultaneously evaluated.
A hybrid type 1 effectiveness-implementation design was used to evaluate the intervention in six health regions across Sweden. A cluster-randomised controlled trial was conducted to evaluate effectiveness, where 40 CHC centres (98 nurses) were randomised into two arms: use the SSiHT material in routine care (intervention), or standard care (control). Parents (n = 698) of 5-year-olds were recruited. Outcome measures were assessed using digital questionnaires before the health talk (baseline), and two months later (follow-up). Linear mixed-effect models were used to contrast differences in outcomes between groups, in accordance with the study protocol. Acceptability, appropriateness, feasibility, fidelity, and adoption were evaluated using questionnaires and checklists to CHC nurses in the intervention group.
No statistically significant intervention effects were found on parental self-efficacy to promote healthy lifestyle behaviours in their children (-0.61 score on a scale 0-160; p = 0.56), nor children's intake of vegetables, fruits/berries, and sweet drinks or screen time (p > 0.05 for all). However, CHC nurses overall reported that the SSiHT material was feasible and appropriate to use in the health talks with families, and they used it in 83% of their health talks.
Although the SSiHT material was well accepted by the CHC nurses, there was no intervention effect on parental self-efficacy (primary outcome) nor health-related behaviours in children when evaluated in Swedish CHC. This warrants further research to better understand how to effectively empower parents through CHC health talks.
Registered 2 February 2022 at Clinicaltrials.gov NCT05237362; https://www.
gov/study/NCT05237362 .
由于生活方式行为在儿童时期就已形成，早期干预对于改善公众健康至关重要。在这方面，儿童保健（CHC）起着关键作用。“健康谈话中的传奇故事”（SSiHT）材料包括一本配有彩色插图的活动挂图，以方便儿童保健护士与家长及其子女进行常规健康谈话，以及一套辅助材料包，以支持家庭中的健康生活方式行为。我们的目的是评估在儿童保健中心进行5年例行检查时，SSiHT干预对父母自我效能感（主要结果）和儿童健康相关行为（次要结果）的有效性。同时评估了在5年检查的常规健康谈话中使用SSiHT材料的实施情况。
采用混合1型有效性-实施设计，在瑞典的六个健康区域评估该干预措施。进行了一项整群随机对照试验以评估有效性，其中40个儿童保健中心（98名护士）被随机分为两组：在常规护理中使用SSiHT材料（干预组）或标准护理（对照组）。招募了5岁儿童的父母（n = 698）。在健康谈话前（基线）和两个月后（随访）使用数字问卷评估结果指标。根据研究方案，使用线性混合效应模型对比两组之间结果的差异。通过向干预组的儿童保健护士发放问卷和清单，评估可接受性、适宜性、可行性、保真度和采用情况。
在促进子女健康生活方式行为的父母自我效能感方面未发现统计学上的显著干预效果（在0 - 160分的量表上得分为 -0.61；p = 0.56），在儿童蔬菜、水果/浆果、甜饮料的摄入量或屏幕使用时间方面也未发现显著效果（所有p值均>0.05）。然而，儿童保健护士总体报告称，SSiHT材料在与家庭进行健康谈话时使用是可行且适宜的，并且他们在83%的健康谈话中使用了该材料。
尽管SSiHT材料受到儿童保健护士的广泛接受，但在瑞典儿童保健中心进行评估时，对父母自我效能感（主要结果）和儿童健康相关行为均未产生干预效果。这需要进一步研究，以更好地理解如何通过儿童保健健康谈话有效地增强父母的能力。
于2022年2月2日在Clinicaltrials.gov上注册，NCT0523XXXX；https://www.CLINICALTRIALS.gov/study/NCT0523XXXX 。 （注：原文中注册号和链接部分有缺失内容，已按格式保留）
