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Published on: February 19, 2021
Implementation of the norwegian 'Starting right' child health service innovation: implementation adjustments,
Thomas Westergren1,2, Eirin Mølland3,4, Kristin Haraldstad3
1Faculty of Health and Sports Sciences, University of Agder, P.O. Box 422, 4604, Kristiansand, Norway. thomas.westergren@uia.no.
Insights
The 'Starting Right' health innovation successfully integrated child and parent feedback for adjustments. Child and school health nurses adopted the online tool, showing high parental acceptability, especially for older children.
Area of Science:
- Child Health Services
- Health Innovation Implementation
- Digital Health Tools
Background:
- Rising rates of impaired health symptoms in children necessitate early identification.
- Structured child- and parent-reported outcome measures are crucial for decision support in child health services.
- The 'Starting Right' innovation aimed to integrate an online assessment tool into child health services.
Purpose of the Study:
- To qualitatively examine implementation adjustments of the 'Starting Right' health service innovation.
- To quantitatively measure practitioner adoption and parental acceptability of the online child health assessment tool.
Main Methods:
- Mixed-methods design utilizing working notes, meeting memoranda, and system logs.
- Pilot implementation involved 21 child and school health nurses (CSHNs) with children aged 2, 4, and 6 years.
- Deductive and narrative analysis based on Fixsen et al.'s core implementation components.
Main Results:
- Implementation components were actively adjusted based on staff evaluations and researcher support.
- A project for improved data systems integration was initiated.
- CSHN adoption rates were high (96% in center A with support, 55% in center B).
- Parental acceptability was high (77% overall), increasing with child age and dual-parental receipt of questionnaires.
Conclusions:
- The 'Starting Right' innovation was successfully implemented through active adjustments based on core components and staff feedback.
- Child and school health nurses demonstrated adoption of the innovation.
- The online health assessment tool was found to be acceptable to parents.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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