Formative research in the development of a salutogenic early intervention home visiting program integrated in public child health service in a multiethnic population in Norway

Abstract

BackgroundFew early intervention programs aimed at maternal and child health have been developed to be integrated in the existing Child Health Service in a country where the service is free, voluntary and used by the majority of the eligible population. This study presents the process and the critical steps in developing the “New Mothers” program.MethodsFormative research uses a mixed method, allowing us to obtain data from multiple sources. A scoping review provided information on early intervention programs and studies, clarifying key elements when framing a new program. Key informant and focus group interviews offered insight of existing challenges, perceptions, identified power structures and offered reflections germane to the identified framework, securing user involvement at all stages. Monthly meetings with the project group enabled feedback loops for the data, securing program advancement.ResultsThe “New Mothers” program was formed based on a salutogenic theory, emphasizing resistance and strengths. Public health nurses in the existing Child Health Service were to offer universally all first-time mothers and children home visits from gestational week 28 until the child reached 2 years, with motivational interviewing and empathic communication as methods to mentor the mothers, help them identify their strengths and resources, and provide support and information.ConclusionsUsing formative research as mixed method ensures incorporation of detailed information from multiple resources when an early intervention program is developed. This method secured program appropriateness, both culturally and at system level, when integrating new elements in the existing service.

The evolution and feasibility of a salutogenic home visit program in multiethnic first-time families in Norway.

“…The fourth area: integration of the New Families program to the CHSC, is presented in table 3 to 5 in relation to the identi ed themes relevant to a future integration. The suggested blueprint for the New Families program implementation evolved with prompts and schemes, and will be discussed related to the initial program framework and foundation (Leirbakk et al, 2018 6. If the New Families program should become a regular offer at the CHSC, do you have any thoughts or ideas of are important for us to consider?…”

“…After the initial phase of de ning the principles and key elements of the program (Leirbakk et al, 2018), a feasibility study was warranted. To ensure strong integration in the current CHSC, three PHNs from the Stovner CHSC were partially bought out of their regular positions to develop the new program.…”

“…Through a period of two years, they conducted home visits to all rst-time families in the district. During this period, the PHNs participated in seminars, bi-weekly meetings with the program coordinator and one of the researchers, and were actively involved in the monthly project group meetings (Leirbakk et al, 2018). The intention was to track the process, share experiences, viewpoints, and identify program facilitators and challenges.…”

“…The three PHNs used two years when adjusting to the new way of working and felt transferring the program to all PHNs at their CHSC called for a blueprint. The blueprint would be a description based on schemes and prompts, but also incorporating the foundations of the program (Leirbakk et al, 2018). In addition, there needed to be speci c training and a follow up of all PHNs new to the New Families program concept and ideas.…”

“…The PHNs in the CHSC focuses on health promotion and primary prevention, with an intention to foster an optimal trajectory for growth and development in children, while providing guidance to parents (Norwegian Directorate of Health, 2017). Thus, when Stovner District in Oslo, in collaboration with the University of Oslo, discussed an early salutogenic home visiting program, the ultimate intention was to integrate the nal program in the existing CHSC (Leirbakk et al, 2018). Widening social disparity, advancing child poverty, and increased use of secondary services called for new and innovative actions (Oslo City, 2016).…”