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To Choose a Band-Aid"Children's Preferences for Participation in Health Care Situations: Q Methodology Study
Merja Hietanen1,2, Maksims Kornevs2, Catarina Nahlén Bose1
1Swedish Red Cross University, Hälsovägen 11 C, Huddinge, Stockholm, 141 57, Sweden, 46 08-587 516 60.
Insights
Preschoolers prefer shared decision-making in healthcare but want adults to make major choices. Empowering children with age-appropriate options respects their rights and supports child-centered care (CCC).
Area of Science:
- Pediatric Healthcare
- Child Psychology
- Bioethics
Background:
- Child-centered care (CCC) emphasizes children's rights and family roles in pediatrics.
- Involving children in healthcare decisions is a right but not always practiced.
- The United Nations Convention on the Rights of the Child advocates for respecting children's views.
Purpose of the Study:
- To explore participation preferences of 3- to 5-year-old children in healthcare.
- To compare children's, parents', and healthcare professionals' views on child participation.
- To understand how to best involve young children in healthcare decisions.
Main Methods:
- Q methodology was employed to rank 25 statements on child participation.
- Responses were gathered from 12 children, 14 parents, and 12 health professionals.
- Factor analysis identified differing perspectives on participation preferences.
Main Results:
- Three main perspectives emerged: direct communication, understanding/shared decision-making, and responsive/child-led participation.
- Children's separate analysis revealed preferences for inclusion, small choices with outcomes, and trust through familiarity.
- Children value situational control and shared decision-making but defer major decisions to adults.
Conclusions:
- Preschoolers can meaningfully participate in healthcare with age-appropriate support and tools.
- Directly acknowledging children's perspectives is crucial, avoiding adult assumptions.
- Findings support child-centered care principles and the UN Convention on the Rights of the Child.
Background:
Child-centered care (CCC) is standard practice in pediatrics, emphasizing the child as an individual with rights while acknowledging the child's role within the family. A key aspect of CCC is the involvement of the child in health care decisions alongside parents and professionals. Although this is a right recognized by the United Nations Convention on the Rights of the Child, it may not always be applied in practice.
Objective:
The aim of this study is to explore the participation preferences of 3- to 5-year-old children in health care from both their own viewpoint (the child's perspective) and the viewpoint of their parents and health care professionals.
Methods:
Q methodology was used to study preferences, comparing responses from 12 children, 14 parents, and 12 health professionals who ranked 25 statements about ways in which children could participate in health care situations. Factor analysis was used to reveal similarities and differences in views on participation preferences. The children's rankings were also analyzed separately for comparison.
Results:
Analysis of rankings from children, their parents, and health care professionals identified 3 perspectives with different preferences: direct communication between the child and healthcare professionals; understanding and shared decision-making; and responsive and child-led participation. A separate analysis of children's rankings resulted in 3 perspectives: being included in and setting their own terms for participation; small choices, meaningful outcomes; and trust through familiarity and shared decision-making.
Conclusions:
This study suggests that children value shared decision-making and situational control but prefer to leave major decisions to adults. It affirms that preschool-aged children can meaningfully participate in health care when given age-appropriate choices, support, and tools. Children's perspectives must be acknowledged directly rather than adults assuming their views. The findings support CCC principles and reinforce the United Nations Convention on the Rights of the Child mandate to respect children's views regarding all issues relevant to them.
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