A better start for health equity? Qualitative content analysis of implementation of extended postnatal home visiting in a disadvantaged area in Sweden

Abstract

BackgroundHealth inequities among children in Sweden persist despite the country’s well-developed welfare system and near universal access to the national child health care programme. A multisectoral extended home visiting intervention, based on the principles of proportionate universalism, has been carried out in a disadvantaged area since 2013. The present study investigates the content of the meetings between families and professionals during the home visits to gain a deeper understanding of how it relates to a health equity perspective on early childhood development.MethodsThree child health care nurses documented 501 visits to the families of 98 children between 2013 and 2016. A qualitative data-driven conventional content analysis was performed on all data from the cycle of six visits per child, and a general content model was developed. Additional content analysis was carried out on the data from visits to families who experienced adverse situations or greater needs.ResultsThe analysis revealed that the home visits covered three main categories of content related to the health, care and development of the child; the strengthening of roles and relations within the new family unit; and the influence and support located in the broader external context around the family. The model of categories and sub-categories proved stable over all six visits. Families with extra needs received continuous attention to their additional issues during the visits, as well as the standard content described in the content model.ConclusionsThis study on home visiting implementation indicates that the participating families received programme content which covered all the domains of nurturing care as recommended by the WHO Commission on Social Determinants of Health and recent research. The content of the home visits can be understood to create enabling conditions for health equity effects. The intervention can be seen to represent a practical example of proportionate universalism.

Theoretical and practical challenges of proportionate universalism: a review

“…In our review, most of interventions were either home visiting and then by nature PU because they are almost individual care, either a sum of actions targeting the most deprived ( 45 , 61 ). Even if they were proportionate most of them were not universal but specifically implemented in deprived area ( 37 , 50 , 62 ).…”

Strengthening resilience through an extended postnatal home visiting program in a multicultural suburb in Sweden: fathers striving for stability

“…In the participating families, 96 fathers were known to have had any contact with the mother and the child. Overall 79% ( n = 76) of fathers attended at least one home visit [8], and 53% ( n = 51) attended two or more home visits and were eligible for the interview study (Fig. 1).…”

“…Ninety-four percent of the included families wanted to participate in the home visiting program and signed a consent from before participating in the program evaluation [6, 7]. Around 79% of the fathers attended at least one extended home visit [8]. There is some estimation from the literature that up to one-half of fathers participate in home visiting programs to some extent when fathers participation is a focus in the programs [9].…”

“…The analysis of the content of the meetings between families and professionals during the home visits based on the CHC nurses’ documentations reveal that the home visits within the extended home visiting program covers three main categories of content related to i) the health, care and development of the child, ii) the strengthening of roles and relations within the new family unit, iii) and the influence and support located in the broader external context around the family [8].…”

Public health nurses’ experiences of using interpreters when meeting with Arabic‐speaking first‐time mothers

“…Inequities in health are systematically distributed along a social gradient as well as between societies (WHO, ). To counteract these inequities, interventions in child health care have been implemented in some disadvantaged areas in Sweden (Barboza, Kulane, Burstrom, & Marttila, ). Individuals who do not speak or understand Swedish have the right to an interpreter when communicating with the health care system (Hadziabdic & Hjelm, ).…”