Exploring Nurses’, Preschool Teachers’ and Parents’ Perspectives on Information Sharing Using SDQ in a Swedish Setting – A Qualitative Study Using Grounded Theory

Abstract

Evidence-based methods to identify behavioural problems among children are not regularly used within the Swedish Child healthcare. A new procedure was therefore introduced to assess children through parent- and preschool teacher reports using the Strengths and Difficulties Questionnaire (SDQ). This study aims to explore nurses’, preschool teachers’ and parents’ perspectives of this new information sharing model. Using the grounded theory methodology, semi-structured interviews with nurses (n = 10) at child health clinics, preschool teachers (n = 13) and parents (n = 11) of 3-, 4- and 5-year-old children were collected and analysed between March 2014 and June 2014. The analysis was conducted using constant comparative method. The participants were sampled purposively within a larger trial in Sweden. Results indicate that all stakeholders shared a desire to have a complete picture of the child's health. The perceptions that explain why the stakeholders were in favour of the new procedure—the ‘causal conditions’ in a grounded theory model—included: (1) Nurses thought that visits after 18-months were unsatisfactory, (2) Preschool teachers wanted to identify children with difficulties and (3) Parents viewed preschool teachers as being qualified to assess children. However, all stakeholders had doubts as to whether there was a reliable way to assess children’s behaviour. Although nurses found the SDQ to be useful for their clinical evaluation, they noticed that not all parents chose to participate. Both teachers and parents acknowledged benefits of information sharing. However, the former had concerns about parental reactions to their assessments and the latter about how personal information was handled. The theoretical model developed describes that the causal conditions and current context of child healthcare in many respects endorse the introduction of information sharing. However, successful implementation requires considerable work to address barriers: the tension between normative thinking versus helping children with developmental problems for preschool teachers and dealing with privacy issues and inequity in participation for parents.

Swedish norms for the Strengths and Difficulties Questionnaire for children 3–5 years rated by parents and preschool teachers

“…Thus, children might either display less emotional and behavioral problems in the preschool setting, or preschool teachers might perceive any such problems as signifying a problem not within the child, but within the preschool environment, thus lowering the proportion of behaviors reported as problematic. In addition, results in a previous study on preschool teachers’ experiences of using the SDQ in the Swedish preschool setting (Fält, Sarkadi & Fabian, ) show that the use of structured assessment forms is considered to be contradictory to the preschool philosophy. Findings from the same study also indicate that teachers are worried about parents’ reactions and fear both making incorrect assessments and labelling children.…”

Identifying Patterns of Emotional and Behavioural Problems in Preschool children : Facilitating Early Detection

“…Collaboration for early detection and intervention Fält, Sarkadi, and Fabian (2017) included preschool and CHN in their study, and reported that the quality of CHC health check-ups for 3-5year-olds improved when they received SDQ ratings from the preschool teacher as well as from the parents. However, successful implementations of this kind require considerable work at several levels; for example, information sharing, privacy issues, the participation of all parents and normative thinking.…”

“…It would probably be better to engage the parents before the child is formally identified and allowed to receive special support. A Swedish study by Fält et al (2017) found that preschool teachers wished to identify children with difficulties, and at the same time parents viewed preschool teachers as being competent in their ability to estimate this type of behaviour in children. However, both preschool teachers and parents wished that there was a more reliable way to assess children's behaviour.…”

“…That said, the CHN already has an established contact with families, often with a home visit during the first week after childbirth onwards, together with a number of regular contacts made during the child's first year of life (National Board of Health and Welfare, 2014). Fält et al (2017) reported that the quality of health check-ups for 3-5year-olds in CHC improved when they had SDQ ratings from the preschool teacher and parents. However, successful implementations of this kind require considerable work at several levels; for example, information sharing, privacy issues, the participation of all parents, and the strain between normative thinking and the notion of preschool teachers helping children who already have developmental problems.…”

Nurses’ experiences of screening for communication difficulties at 18 months of age

“…In Fält et al. , nurses believed that the CHS does not reach the parents in greatest need when self‐report documents place high demands on parents. Health outcomes in young children are also related to parental literacy .…”