Promoting and hindering factors for implementation of the Infant Stool Colour Card in Dutch youth health care organizations
Related Experiment Video
Updated: Sep 19, 2025
E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
L T Warris1,2,3, C A Dogger4, S A Reijneveld5
1Dept. of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. l.t.warris@umcg.nl.
Insights
Early detection of biliary atresia using the Infant Stool Colour Card (ISCC) is crucial. Successful implementation in youth health care requires addressing knowledge gaps and ensuring proper training for professionals.
Area of Science:
- Pediatrics
- Public Health
- Implementation Science
Background:
- Biliary atresia is a rare, severe infantile cholestatic disease.
- Early diagnosis and treatment significantly improve patient prognosis.
- Delayed diagnosis is a problem in the Netherlands, despite the Infant Stool Colour Card (ISCC) improving detection elsewhere.
Purpose of the Study:
- To identify factors promoting and hindering the implementation of the Infant Stool Colour Card (ISCC) in Dutch youth health care (YHC) organizations.
- To understand barriers to early biliary atresia detection.
- To inform strategies for successful ISCC integration into standard YHC practice.
Main Methods:
- Qualitative study utilizing semi-structured interviews.
- Inclusion of both implementing and non-implementing Dutch YHC organizations.
- Interviews with youth public health (YPH) physicians and nurses using a framework based on the Consolidated Framework of Implementation Research.
Main Results:
- Key promoting factors included positive professional attitudes, perceived competence, ISCC simplicity, workflow compatibility, and stakeholder involvement.
- Major hindering factors involved limited knowledge of biliary atresia among YPH professionals and GPs, inadequate risk perception, poor ISCC integration (lack of training, no designated lead), and insufficient GP collaboration.
Conclusions:
- Comprehensive, interactive training on the ISCC's rationale and use is essential for YPH professionals and GPs.
- Designating a responsible professional is critical for successful ISCC embedding within YHC organizations.
Abstract:
Biliary atresia is a rare life-threatening cholestatic disease of early infancy, and early treatment largely improves its prognosis. Currently, use of the Infant Stool Colour Card (ISCC) to improve early detection is implemented in several youth health care (YHC) organizations in the Netherlands. We aimed to map the promoting and hindering factors for implementation of the ISCC. We performed a qualitative study with semi-structured interviews among small and large Dutch YHC organizations. We included organizations that implemented the ISCC, and that did not. For both, we interviewed youth public health (YPH) physicians and nurses involved in the organizational policy regarding hyperbilirubinemia, using an interview topic guide based on the Consolidated Framework of Implementation Research. Ten of 17 approached YHC organizations participated (with 10 physicians and 3 nurses), among which all three organizations that implemented the ISCC. Major promoting factors were the positive attitudes of YPH professionals towards the ISCC, a sense of competence among YPH professionals, the ISCC's simplicity, the compatibility with workflows, and the involvement of key stakeholders. Major hindering factors were limited knowledge and inadequate risk perception of biliary atresia among YPH professionals and general practitioners (GPs), insufficient ISCC integration within YHC organizations (lack of repeated training and lack of a designated responsible professional), and insufficient collaboration with GPs.
Conclusion:
To implement use of the ISCC, comprehensive, interactive training and education on its rationale and use for YPH professionals and GPs are essential. The successful embedding of the ISCC into YHC organizations requires a designated professional.
What Is Known:
• There is a delay in diagnosing biliary atresia in the Netherlands. • The Infant Stool Colour Card led to earlier diagnosis and surgery in different countries, which largely improves the prognosis of biliary atresia.
What Is New:
• The Infant Stool Colour Card is included in the new Dutch national guideline 'Early detection and diagnosis of biliary atresia' as a standard screening method in case of prolonged jaundice in youth health care organisations. • This study maps barriers and promoting factors of the ISCC to ensure successful implementation within Dutch youth health care organisations.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:29Assessment of the Gastrointestinal System II: Health Perception Pattern
Health Perception Patterns
Health perception patterns offer valuable insights into a patient's lifestyle habits and how they may impact their GI health. These patterns include:
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:26Levels of Health Promotion and Illness Prevention
In primary prevention, actions taken before disease onset prevent the disease from...
01:14Changes in Skin Color: Clinical Perspectives
Albinism
Albinism is a genetic disorder that affects (completely or partially) the coloring of skin, hair, and eyes. The defect is primarily...
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...