Communicating psychosocial problems in German well-child visits. What facilitates, what impedes pediatric exploration? A qualitative study

Krippeit, Lorena; Belzer, Florian; Bouar, Heike Martens-Le; Mall, Volker; Barth, Michael

doi:10.1016/j.pec.2014.07.032

Cited by 12 publications

(13 citation statements)

References 37 publications

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“…However, the services differ widely in scope and not all providers of services are equally equipped for meeting the different needs: for instance, paediatricians in Germany were found to be reluctant and to struggle to address psychosocial problems during the child health check-up examinations. 17 18 This was also shown for other health professionals in studies from Ireland and Canada: midwives and nurses experienced many barriers when dealing with mental health issues of their patients. 19 20 …”

Section: Discussionmentioning

confidence: 80%

Information on, knowledge and utilisation of support services during pregnancy and after childbirth: cross-sectional analyses of predictors using data from the KUNO-Kids health study

Brandstetter

Rothfuß²,

Seelbach-Göbel

et al. 2020

BMJ Open

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ObjectivesTo investigate mothers’ knowledge and utilisation of antenatal and perinatal support services as well as predictors of knowledge and service utilisation.DesignCross-sectional study.SettingProspective birth cohort in Regensburg, Eastern Bavaria, Germany.Participants2455 mothers after delivery.Outcome measuresParticipants’ knowledge of distinct antenatal and perinatal support services (poor vs good, defined by median split). Participants’ use of antenatal services provided by midwife (yes, no) and of any other antenatal support services (yes, no).ResultsThe vast majority of mothers knew at least some support services. Two-thirds of women (68.4%) reported to have used the services provided by midwives. 23.6% of women reported to have used at least one of the other antenatal services. Good knowledge of services was associated with higher education (OR 1.37, 95% CI 1.13 to 1.67), no migration background (OR 2.26, 95% CI 1.76 to 2.90), better health literacy (OR 1.04, 95% CI 1.03 to 1.06), while being primiparous (OR 0.72, 95% CI 0.60 to 0.86) and being unmarried/living with a partner (OR 0.71, 95% CI 0.57 to 0.89) reduced the chance. Predictors of service utilisation differed with regard to the services considered.ConclusionsOverall, mothers had a good level of knowledge of antenatal and perinatal support services. However, we found that some groups of women were less well informed. This inequality in social predictors of knowledge of services was also partly reflected in differences in service utilisation during pregnancy.

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Section: Discussionmentioning

confidence: 80%

Information on, knowledge and utilisation of support services during pregnancy and after childbirth: cross-sectional analyses of predictors using data from the KUNO-Kids health study

Brandstetter

Rothfuß²,

Seelbach-Göbel

et al. 2020

BMJ Open

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“…Our findings suggest that the parents' persistence can trigger the GPs' awareness. Since parents have different conversational styles and varying resistance to expression of emotional concerns during a consultation [12,18] this may lead to the concerns of less insistent parents being left unexplored.…”

Section: Discussionmentioning

confidence: 99%

“…Although these tools can ensure that concerns are touched upon, they do not necessarily influence what happens after the concern has been raised. To our knowledge, only a few studies have investigated how physicians respond to concerns in paediatric settings [17,18]. These studies show that the physician's response, the topic of the concern and parental openness may all determine the extent of parental disclosure [17,18].…”

Section: Introductionmentioning

confidence: 99%

“…To our knowledge, only a few studies have investigated how physicians respond to concerns in paediatric settings [17,18]. These studies show that the physician's response, the topic of the concern and parental openness may all determine the extent of parental disclosure [17,18]. The interaction between health visitors and first-time mothers has also been studied [19].…”

Section: Introductionmentioning

confidence: 99%

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Dealing with parental concerns: A study of GPs' practice

Wilson

Graungaard

et al. 2020

Patient Education and Counseling

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Objective: To investigate patterns of GPs' exploration and termination of dialogues about parental concerns in preventive child health assessments. Methods: Interactional microanalysis of video recordings of 32 preventive child health assessments using conversation analysis. Results: The GPs asked parents about concerns, but most concerns disclosed by parents were still left unexplored at the end of the consultation. Termination of dialogues about concerns could be achieved effectively by GPs through letting the biomedical agenda dominate or addressing the child directly. The parents generally cooperated with the various approaches to handling concerns. Conclusion: GPs displayed initial attentiveness towards emotional concerns but did not always follow through with subsequent exploration; many concerns raised were left unexplored. However, the same GP could employ both non-exploratory and exploratory practice within individual consultations. Practice implications: Preventive child heath assessments offer an opportunity for parents to raise concerns about their children's development. Improved understanding of the conversational mechanisms through which concerns are examined or sidelined could allow clinicians to maximise the effectiveness of their preventive consultations.

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“…2 Yet, despite this critical role, families who turn to their family physician for mental health can feel dismissed and unheard. 3,[4][5][6][7][8] Moreover, rural PCPs report lacking the confidence and adequate training to provide this care themselves. 9,10 There may be an association between PCPs' mental health care confidence and the actual care they provide.…”

Section: Abstract Primary Care Practitioner Rural Pediatric Mentamentioning

confidence: 99%

Primary Care Practitioner Training in Child and Adolescent Psychiatry (PTCAP): A Cluster-Randomized Trial

et al. 2019

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Objectives Rural primary care practitioners (PCPs) have a pivotal role to play in frontline pediatric mental health care, given limited options for referral and consultation. Yet they report a lack of adequate training and confidence to provide this care. The aim of this study was to test the effectiveness of the Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program, which was designed to enhance PCPs’ pediatric mental health care confidence. The program includes brief therapeutic skills and practice guidelines PCPs can use to address both subthreshold concerns and diagnosable conditions, themselves. Methods The study design was a pilot, cluster-randomized, multicenter trial. Practices were randomly assigned to intervention ( n practices = 7; n PCPs = 42) or to wait-list control ( n practices = 6; n PCPs = 34). The intervention involved 8 hr of training in practice guidelines and brief therapeutic skills for depression, anxiety, attention deficit hyperactivity disorder, and behavioral disorders with case discussion and video examples, while the control practiced as usual. A linear random-effects model controlling for clustering and baseline was carried out on the individual-level data to examine between-group differences in the primary (i.e., confidence) and secondary (i.e., attitude and knowledge) outcomes at 1-week follow-up. Results Findings were a statistically significant difference in the primary outcomes. Compared to the control group, the intervention group indicated significantly greater confidence in managing diagnosable conditions ( d = 1.81) and general concerns ( d = 1.73), as well as in making necessary referrals ( d = 1.27) and obtaining consults ( d = 0.74). While the intervention did not significantly impact secondary outcomes (attitudes and knowledge), regression analysis indicated that the intervention may have increased confidence, in part, by ameliorating the adverse impact of negative mental health care attitudes. Conclusion PTCAP enhances PCPs’ child/youth mental health care confidence in managing both general and diagnosable concerns. However, an 8-hr session focused on applying brief therapeutic skills was insufficient to significantly change attitudes and knowledge. Formal testing of PTCAP may be warranted, perhaps using more intensive training and including outcome assessments capable of determining whether increased PCP confidence translates to more effective management and better patient outcomes.

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Communicating psychosocial problems in German well-child visits. What facilitates, what impedes pediatric exploration? A qualitative study

Cited by 12 publications

References 37 publications

Information on, knowledge and utilisation of support services during pregnancy and after childbirth: cross-sectional analyses of predictors using data from the KUNO-Kids health study

Information on, knowledge and utilisation of support services during pregnancy and after childbirth: cross-sectional analyses of predictors using data from the KUNO-Kids health study

Dealing with parental concerns: A study of GPs' practice

Primary Care Practitioner Training in Child and Adolescent Psychiatry (PTCAP): A Cluster-Randomized Trial

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