https://www.mdu.se/

Children in need of special support in preschool (INS) often exhibit delayed time processing ability (TPA) which can significantly impact their everyday functioning (EDF).This study evaluates whether the MyTime intervention could improve TPA and EDF in preschool children aged five to six-year INS.A registered randomized controlled trial (ISRCTN85136134) using a waiting-list control group investigated the effectiveness of MyTime, an occupational therapy intervention program given to preschool children INS in their classrooms for 8 weeks. Data collection included KaTid-Child (R) for the assessment of TPA, the Time-Parent scale, the Adaptive Behavior Assessment System, and the Autonomy scale for assessing EDF. To evaluate between-group differences, data were analyzed using linear regression.The results show that both groups improved from baseline to post-intervention in TPA and everyday functioning but at the post-intervention, there were no between-group differences.To summarize, the MyTime intervention, indicated an increase in TPA and EDF but no between-group differences were found. Early cognitive levels of TPA in preschool children INS advocate for a longer intervention period. It is possible that long-term follow-up or additional measuring of the teacher's attitudes and the children's engagement in the preschool context could have yielded other results.

AimThe aim of the study was to explore meaningful everyday life situations as perceived by six-year-old children born preterm. Materials and methodsThe study had a descriptive qualitative design with an inductive approach. Ten, six-year-old children born preterm, not diagnosed with any disabilities, participated. Data was collected by photo-elicitation interviews to stimulate and help the children to describe their meaningful everyday life situations. A qualitative content analysis according to Elo and Kyngas was applied. ResultsThe children's descriptions of meaningful everyday life situations can be understood as being in an active and dynamic process, representing the core category. The analysis resulted in three generic categories, as the children described the significance of having significant circumstances and doing things. The experiences the children gain when they do things create their desire for further development. DiscussionThe results reveal that children born preterm are able to reflect on and give detailed descriptions of situations of importance to them. The study suggests that if six-year-old children born preterm are given the opportunity to share their views they can take an active role e.g. in planning and carrying through of interventions by health care services.

Children's participation in decision-making in the health care setting is complex because parents and health professionals tend to take a protective stance towards children to act in their best interest. Children prefer to be protected in some situations and to share decision-making in others. Adults in the health care setting need to consider children as individuals, rather than as a homogenous group, and take into account that a child's competence and preferences will depend on the circumstances in every situation. This article argues for a situational perspective of children's participation to act in the child's best interest and to balance protection with shared decision-making, according to children's rights and desires.

Objective: To describe general practitioners' (GPs') accounts of how to facilitate consultations with children aged 1-2 years. Design: A qualitative study based on focus group interviews. Setting and subjects: Five focus group interviews were conducted with a total of 25 GPs at Swedish primary health care (PHC) centres. The GPs regularly invited toddlers to consultations. Result: The GPs' accounts of how to facilitate consultations with toddlers revealed descriptions of making efforts to instil confidence in the situation to enable the consultation. Toddlers in need of health care always visit the GP with adults such as their parents, guardians or other relatives. Therefore, the GP directs efforts towards the adults and the child more or less simultaneously, as they both need to rely on the GP. The GPs describe how they instil confidence in the adults by establishing a mutual understanding that the consultation is necessary to secure the child's health. Regarding the child, the GP instils confidence by establishing a relationship in order to approach the child and accomplish bodily examinations. Conclusion: The result shows that GPs' encounters with children in consultations are two-sided. The GP needs to conduct bodily examinations to secure the child's health and development, but to do so he/she needs to establish purposeful relationships with the adults and the child by instilling confidence. This indicates that establishing relationships in the consultation is significant, and a way to achieve a child-centred consultation.

Background:Throughout childhood, children take part in health visits according to a health-monitoring programme. The visits are aimed to promote the children’s development and health and to strengthen them to take own responsibility for their health. Nurses’ actions when encountering children at these visits are not explored to any great extent. Exploring nurses’ actions can facilitate their reflections on their actions towards children and thereby promote children’s involvement in such visits. Aim: The aim of this study was to explore nurses’ actions when encountering children at health visits. Method: A qualitative explorative design, based on 30 video recordings of health visits in child and school health care, was used in this study. These visits were ordinary real-life health visits. The data were subjected to qualitative content analysis. The right to conduct video recordings during health visits was approved by appropriate research ethics committees. Results: The findings show that nurses, in order to carry out the health visits, encounter children through negotiated guidance. This guidance is understood as the process through which the nurses reach agreement with the children, and is comprised of directed and pliable strategies. At one moment, the nurse can use a directed strategy to inform the child and at the next moment a pliable strategy to provide the child space within the given frame, the health-monitoring programme. By using these strategies intertwined, the nurse can provide the child space within the given frame and, at the same time, fulfil his/ her responsibility to promote children’s health and development. Conclusion: The results highlight nurses’ challenging and complex assignment of guiding children to promote their engagement in the health visits, thereby enabling the nurses to promote the children’s health and development according to the national health-monitoring programme.

The aim of this study is to investigate child health care nurses' cultural competence in health visits with children and their families of foreign background. Design: A cross-sectional design combined with a qualitative explorative design. Methods: The nurses assessed their cultural competence using a modified version of the Clinical Cultural Competency Questionnaire. Interviews were used to obtain a detailed description of the nurses' cultural competence. Results: The nurses assessed themselves as rather culturally competent. They scored above mid-score in the total score for cultural competence and on all subscales. Education in cultural diversity at the nurses' workplace had the highest association to cultural competence. The nurses described their awareness as recognizing each child and her/his family rather than their cultural background, and viewing the child as a unique part of her/his cultural context. Despite their high scores on cultural competence, the nurses described a lack of cultural knowledge and explained their need of further knowledge.

Nurses in the Swedish child healthcare system can make a difference by offering support to parents of children who areoverweight or at risk of becoming so. Still, research concerning these nurses’ clinical practice when encountering parents whosechild is overweight is inadequate. The aim of this study was to describe nurses’ clinical practice when encountering parents of anoverweight child. Data were collected through interviews with 10 nurses, and a content analysis approach was used. The nurses’clinical practice is described in relation to Olander’s theory: Individualising actions, Creating a dialogue, Documenting, andFocusing on normality. This study adds knowledge about nurses’ clinical practice in encounters with parents whose child isoverweight. Also, it adds information on how an issue in a specific care situation may contribute to further understanding anduse of an existing theory in caring science.

Background: To prevent diseases among children they regularly undergo immunizations. Previous research show different approaches available to facilitate immunization-procedures for children to protect them from harm. To complement this research and provide care suited for children, research recognizing their perceptions of undergoing such a procedure is needed. Aim: The aim of this study was to describe 5-year-old children's perceptions of undergoing an immunization. Method: A phenomenographic approach and analysis was used to describe the children's (n = 21) various perceptions. The data-collection was accomplished directly after the immunization to grasp the children's immediate perceptions. Drawings and reflective talks were used as they are considered as suitable methods when involving young children in research. The right to conduct research with children was approved by the appropriate research ethics committee and also by each child and the parents. Results: The findings show that children's perceptions of an immunization-procedure may vary from effortlessly, to manageable or difficult. Regardless of how the child perceive the immunization-procedure each perception embrace the children's descriptions of actors and articles in the situation, their feelings in the situation and also their actions to deal with the immunization. Nevertheless, these descriptions vary according to how the children perceive the immunization as effortlessly, manageable or difficult. Conclusion: Children's and adults' perceptions of medical procedures may differ and children need guidance, time and space to deal with them. Recognizing children's perceptions of undergoing an immunization contributes to the promotion of their right to be involved in their own health care and towards the development of child-centred care. 

In this article, we have explored 5-year-old children's expressions when they as actors took part in an immunization situation in the Primary Child Health Care (PCHC) service in Sweden. Although children's health and development are the main concern in the PCHC service, their perspectives in such a setting have not been explored fully. To capture children's perspectives we used a hermeneutic design and video observations. The findings revealed children as competent and active participants, contributing to the construction of the PCHC situation in mutuality with the nurse and the parent. The conceptualization of children's expressions and actions revealed how they influenced and dealt with a PCHC situation by using strategies of tuning-in, affirmative negotiation, and delaying negotiation. Understanding children's actions will assist nurses to act with sensitivity when they encounter and support children.

In the Swedish Primary Child Health Care (PCHC) children participate in regular health visits. In these visits children as actors demonstrate their subjective maturity through bodily and verbal expressions. The aim of this study was to explore three-year-old children's expressions when they take part as actors in a PCHC situation. An explorative design with a hermeneutic approach and video observations was used. Twenty-nine children participated. The findings exhibit a variation of expressions in the situation conceptualized as actions in a progression of states: from a state of getting ready to a state of being ready and further to a state where the child strengthens their own self. This progression is dynamic and coloured with the states of not being ready or of being adverse. The conceptualization of children's expressions can contribute towards encouraging nurses' sensitivity when inviting and guiding children in PCHC situations.

In Sweden, children’s health and development are promoted through Primary Child Health Care (PCHC) visits. The children participate in these visits from their own perspective through bodily and verbal expressions. This study explores four-year-old children’s expressions when they as actors take part in a PCHC situation. The conceptualisation of the children’s expressions reveals various actions that exhibit their affirmative and delaying negotiation strategies to influence and deal with these situations. For PCHC nurses, these findings may encourage to view children as negotiating participants and inspire to sensitivity when inviting children and guiding them through health visits

Four year old Children’s strategies of negotiation when they are holding a Primary Child Health Care situation

The Swedish Primary Child Health Care (PCHC) is assigned to promote children’s (age 0-5) health and development through regular health visits. A child’s first year involves several health checkups, then planned health visits take place at 3, 4 and 5,5 years of age. These health visits is a part of a monitory program to examine the child’s speech development, motor and cognitive functions. During the health visit the child and the parent will meet a PCHC nurse. Recently, the child’s perspective as an actor in the health visit was explored. The result demonstrated how three year old children exhibit various actions in a progression of states. The child progress from a state of getting ready to a state of being ready and further to a state where the child strengthens the own self. This progression is dynamic and coloured with the states of not being ready or of being adverse. The aim of present study is to describe the four year old children’s strategies when they are holding a PCHC situation. The study has an explorative design with a hermeneutic approach and video-observations are used. Twenty-nine children participate and the selection is strategically. Informed consent was gained in writing from all children, parents and nurses. The findings exhibit how the children use various strategies of negotiation when they are holding a PCHC situation. Illuminating children’s perspective by conceptualizing their expressions and strategies may contribute towards encouraging the PCHC nurse’s sensitivity when inviting and guiding children in the health visit.

Preschool children's expression of participation in primary child health care

Introduction

According to The Convention on the Rights of Child children have the right to have their voice heard and to participate in situations that involve them.

Aim of the study

The aim of this study was to explore and describe the expression of participation of 3-year old children during their annual primary health care visit.

Methods

The study employed qualitative research design using video-observation, and focused on the actions of twenty-nine 3-year olds in their interaction with the nurse. The varying expressions of the children were captured using hermeneutic analysis.

Results

The findings demonstrate how 3-year old children prepare themselves for particiaption prior to their health care visit. They arrange their bodies in different positions, ask questions, seek contact with their parent or are absorbed in their thoughts. The children then direct their attention towards the health care activity, by using bodily and/or spoken expressions they respond to the nurse´s invitations. When the children have replyed to the invitation they confirm them self. Findings also show children´s expressions of unpreparedness and reluctance in the health care situation.

Conclusion / discussion

Children’s participation occupies either all or part of the body and bodily expressions replace each other in a rapid progression. Children´s spoken expression strengthens their bodily expression.

Practical relevance

Studying pre-school children’s expressions in the child health care environment can contribute to promote their participation in their interaction with nursing staff.

Research implications

This research project will continue by studying the expression of perceived participation of children at 4 and 5,5 years of age during their annual primary health care visit.

References

Allmark, P. (2002). The ethics of research with children. Nurse researcher, 10 (2), 7-20.

Bronfenbrenner, U. (1979). The ecology of Human Development. Cambridge, Mass. Harward university press.

FA, Ministry for Foreign Affairs, (1989). The Convention on the Rights of the Child.

Fraser, S., Lewis, V., Ding, S., Kellet, M. & Robinsson, C. (2004). Doing research with children and young people. London: Sage Publications.

Hammersley, M. & Atkinson, P. (1995). Ethnography. Principles in Practice. London: Routledge

Ministry for Health and Social Affairs. (2005). Mötet med barnet. Barnkompetens inom hälso-och sjukvården. 2005.031

National Board of Health and Welfare. (1991). Allmänna råd från socialstyrelsen 1991:8. Hälsoundersökningar inom barnhälsovården. Stockholm: Allmänna förlaget.

Schutz, A. (1967). The phenomenology of the Social World. Evanston: North-western Univ. Press.

Preeschool children’s expressions of engagement in primary child health care

Children have their right to give their voice and participate in situations which they are engaged in, according to The Convention on the Rights of Child. The aim of this study was to explore and describe 3 year old children’s expressions of engagement during annual child health care visit.

A qualitative research design with video-observations was used. Twenty-nine 3 year old children’s actions were focused when interplaying with the nurse. A hermeneutic analysis was carried out to grasp the children’s varied expressions.

The findings demonstrate how 3 year old children, when invited to the health care activity, are preparing themselves to readiness for engagement. They arrange their bodies in different positions, ask questions, seek contact with parent or are absorbed in thoughtfulness. Then the children direct their attention towards the nurse and/or the health care activity with spoken and/or bodily readiness. Children’s engagement occupies the whole body or separate parts of the body. Further, findings demonstrate how bodily expressions replace each other in a rapid process and how the same expressions can have different meaning depending on actual situation. The children’s spoken expressions: strengthen bodily expressions, are responding to nurses’ invitations or are spontaneously conversation.

This research project will continue to study expressions of engagement and perceived participation of the children at 4 and 5,5 years of age at their annual primary child health care visits. To take preschool children’s engagement in primary child health care settings into consideration can contribute to promote their participation when interacting with the nurse.

Nurses in Swedish child and school healthcare need to balance their assignment of promoting children's health and development based on the national health-monitoring programme with their responsibility to consider each child's needs. In this balancing act, they encounter children through directed and pliable strategies to fulfil their professional obligations. The aim of this study was to analyse the extent to which nurses use different strategies when encountering children during their recurrent health visits throughout childhood. A quantitative descriptive content analysis was used to code 30 video recordings displaying nurses' encounters with children (3-16 years of age). A constructed observation protocol was used to identify the codes. The results show that nurses use pliable strategies (58%) and directed strategies (42%) in encounters with children. The action they use the most within the pliable strategy is encouraging (51%), while in the directed strategy, the action they use most is instructing (56%). That they primarily use these opposing actions can be understood as trying to synthesize their twofold assignment. However, they seem to act pliably to be able to fulfil their public function as dictated by the national health-monitoring programme, rather than to meet each child's needs.

Objectives

Early parental support, provided by nurses within child health services, aims to strengthen parents in their parenthood. The aim of this integrative review is to describe communication in parental support in encounters between child health nurses and parents in child health services.

Methods

An integrative review was conducted. The databases Cinahl+ , MedLine, Psych Info, and Scopus were searched, 312 articles were screened, and 16 articles were found to be eligible.

Results

The studies included qualitative and quantitative methods, using interviews, focus group interviews, and observations. The findings show an overarching theme: The significance of mutuality in communication in a professional-parental relationship, further described in the following categories, 1) Authoritarian approach: a controlling manner, a neglecting manner, and a teaching manner; 2. Guiding approach: a counselling manner and a compliant manner.

Conclusions

The communication between nurses and parents can be understood as having several layers; the organisational context, the professional skills, knowledge, and experiences, and parents’ knowledge, expectations, and needs. There is a lack of studies of authentic communication between nurses and parents; thus, future research is warranted.

Practice implications:

The authoritarian and guiding approaches in parental support show the required skills a nurse is expected to have, but sufficient organizational prerequisites are also crucial.

Background: Primary Healthcare Centers (PHC) are the first instance to seek care for patients who are not acutely ill. Children between 0-18 years account for 23 % of all doctor visits at PHC. These children rarely arrive by themselves; they are accompanied by parents or guardians. Thereby the health care professionals (HCP) need to relate to two individuals in the care situation. Parents are a resource for their child, and they should be given the opportunity to participate with the child in caring situations. The care relation influences the outcome of the encounter between parent, child and HCP. Aim: To describe HCP' reflections about the encounters with parents seeking care for their children at the PHC. Method: A qualitative content analysis with inductive approach was used. The analyzed material consists of HCP's reflections derived from a prior research project regarding children's involvement. Results: Encountering parents who seek care for their children at PHC means that HCP's in these care situations balance between different perspectives and expectations. This balance includes reflections that are described as: To have beliefs about parent's perceptions and expectations; To encounter parents and children as a unit and unique individuals and To guide parents. Conclusion: The prerequisite for district nurses to create a caring relationship with parents and children in a care situation involves understanding and encountering parents’ and children’s perspectives. A caring relationship benefits the care situation, the child's health and parent's trust in the HCP's. 

Keywords Care relation, Health Care Professionals, Parents, Primary Healthcare Center, Qualitative content analysis, Reflections

Hur uttrycker små barn sin delaktighet vid hälsobesök och i vårdsituationer?

Att ha möjlighet att ge uttryck för sitt perspektiv i alla situationer innebär att få vara delaktig vilket hör till ett barns rättigheter. Att fånga barns perspektiv vid ett hälsobesök inom Barnhälsovården eller i en vårdsituation är att ge barnet möjlighet att uttrycka sin kompetens och att göra sin röst hörd. Barn uttrycker sitt perspektiv med kropp (gester, ansiktsuttryck och kroppsrörelser) och röst (tal, ljud). För små barn som ännu inte utvecklat språkets förmåga fullt ut är kroppen viktigt redskap i interaktion med andra. Med sin kropp visar barnet sina intentioner och handlar därefter vilket också påverkar andra i samma situation. Barnets mognad och erfarenheter avgör med vilka uttryck barnet agerar situationsanpassat.

Vi har använt videoobservationer för att upptäcka barns uttryck när de deltar i aktiviteter inom hälsobesök eller i vårdsituationer. Dessa har analyserats för att söka förståelse utifrån barnets perspektiv.

De varierande uttryck som treåriga barn visade i en hälsobesöksituation formade deras handlingar i en progress av olika tillstånd. När barnet inbjuds av sjuksköterskan att delta i en aktivitet rörde det sig från ett tillstånd att göra sig redo, till att vara beredvillig, och vidare till ett tillstånd där det bekräftade sig självt. I denna progress visade sig även tillstånd då barnet inte var redo eller var avogt inställd.

I vårdsituationer med treåriga barn visade barnen uttryck som formade en progress av engagemang på varierande sätt. Efter att ha fått någon form av inbjudan till en aktivitet visade barnen vaksamhet. Denna vaksamhet övergick vidare antingen till ett nyfiket engagemang eller till ett engagemang av följsamhet.  Efter inbjudan och visad vaksamhet med fortsatt misstro mot aktiviteten kunde dock sjuksköterskan och/eller förälder påtvinga barnet till att visa ett motsträvigt engagemang vilket ibland övergick till att barnet visade resignation. 

Att tydliggöra barns uttryck, handlingar, tillstånd och engagemang i olika situationer inom hälso- och sjukvård kan medverka till att utveckla vårdpersonalens lyhördhet för vad som är barnets perspektiv i sitt arbete för att se till barnets bästa, vilket är intentionen för hur konventionen om barns rättigheter förverkligas och implementeras.

USING VIDEO TECHNIQUE TO CAPTURE PRESCHOOL CHILDREN’S PARTICIPATION

Exploring preschool children’s actions to reveal the way they participate in health care situations is a methodological challenge. This challenge lays in capturing children’s expressions, spoken words and body language. Using video technique during observation offers an opportunity to reveal small changes in children’s expressions that might be failed to secure when using the human eye solely. However, video observation is not only about pushing the ‘rec-button’. It requires both methodological and ethical considerations in advance: What is to be in focus during the video observation? What decides when each observation begins and ends? How much time must be devoted for fieldwork and complementary work? Further, the researcher needs to get informed consent from everyone involved. Constant reflexivity during the initial phase, video observations, transcriptions and analysis is also important as the researcher’s presence will influence the final outcome. When transcribing, the researcher’s predetermined focus guides the selection about what to transcribe. To accomplish a selection when transcribing is necessarily to not get lost in the gathered data. The opportunities to see the same sequence several times and to share the observations with a more experienced researcher can contribute to trustworthiness. Therefore, to describe and discuss video observation as a methodological issue is important. Video observations provide rich and thick information that can bring understanding to children’s participation in a detailed and varied way.

Purpose: Encounters between health care professionals, parents and children in health care services for children are complex as these encounters involve the various perspective and understanding of each person involved. The aim of the study is to describe health care professionals’ understanding of significant encounters with children and parents to uncover the meaning of participation. Method: A qualitative descriptive design was applied. The health care professionals’ narratives (n = 35) of their significant encounters with children were interpreted from the perspective of participation. A phenomenological-hermeneutical approach was used in the analysis. Results: The findings show children’s participation as a dynamic movement in mutuality and alienation which can vary within a situation or between different situations involving the same persons. The movement can occur in mutuality and or in alienation depending on what or towards whom the persons direct themselves. Understanding participation as a movement in health care situations is useful in supporting children’s opportunities to participate from their own perspective and deal with health care examinations. Conclusion: The outcome of a situation can never be predicted. Still, professionals can be aware of their actions in encounters with children.

Facilitating young children’s participation in health care situations Background An initiative was given to perform a collaborative research project with health practices in Sörmland on facilitating young children’s participation in health care situations. Departing from workshop with healthcare professionals conveyed that it is an ambiguous challenge to be in care situations with children since each situation depends on its participants; the child, the parents and the professionals. These findings were used in reflective forums to integrate theory and practice to broaden the professionals’ awareness of the child’s perspective in care situations. The project is inspired by a clinical application research (CAR) design, where scientifically trained researchers work with health care professionals, building a team to exchange experiences related to data collection, interpretations and the applicability of the results.

The use of research involves a process of learning as well as engaging beliefs and actions, and these questions are foundational for the practice of clinical care. Such approach aims at facilitating the use of research in clinical practice, to reduce the eventual gap between theory and its practical application.

The overall aim of the project is to facilitate young children’s participation in their health care situations Method and Material The CAR design involves understanding, interpretation and application. This means reflecting on care situations and being confronted with assumptions from theoretical perspectives as well as training an openness and awareness in caring encounters. The team work is in a continued progress and will last during 2014. The data analysis will then proceed.

Result :Some preliminary result will be presented about the process and outcome of the clinical application research Clinical implications: This study may contribute to the stock of knowledge regarding the implementation of an interactive communicative device with the purpose to facilitate young children’s participation in their health care situations.

Introduction: Encounters with children of foreign origin call for school nurses' cultural competence during the health visits. This study aimed to investigate the statistical associations between the cultural constructs described by the Process of Cultural Competence in the Delivery of Healthcare Services (PCCDHS) model and whether school nurses' cultural encounters, cultural knowledge, and cultural skill could statistically predict their cultural awareness. Methodology: Spearman correlation and hierarchical regression analyses were conducted using cross-sectional secondary data from 816 Swedish school nurses. The cultural constructs in the theoretical description of the PCCDHS model guided the selection and sorting of the items on cultural competence. Results: The constructs of cultural knowledge, cultural skill, cultural encounters, and cultural awareness were positively correlated with each other. However, becoming culturally aware was not statistically predicted by included cultural constructs (R-2 = 13.4, p = .06). Discussion: Despite the interrelations between the investigated cultural constructs of the PCCDHS model, understanding cultural awareness development requires further empirical testing.

This systematic review aimed to identify how children's right to health, connected to the principles of protection, promotion, and participation, and from the perspectives of children, parents, and professionals in preschool, school, and healthcare has been empirically demonstrated by international scholars between 1989 and 2021. Following the standards of PRISMA-P, two searches, in 2018 and 2020, were conducted in seven databases. In total, 561 studies were found and after the screening process, which entails reviewing titles, abstracts, and full text-versions, 49 studies were finally included. A deductive qualitative content analysis, proposed by Elo and Kyngas, was performed. According to the findings, protection was demonstrated as Being protected from harmful acts and practices and being entitled to special care and assistance. Promotion was demonstrated as Possessing of resources and Receiving of services, and participation as Being heard and listened to and Being involved in matters of concern. Conforming to the findings, although presented separately, protection, promotion, and participation could be understood as interrelated concepts. In summary, children's right to health was demonstrated within two major fields: as the use of their own resources, and trust and as aspects provided by adults as support and safety. This is the first review of studies, published 1989-2021, identifying children's right to health through the perspectives of protection, promotion, and participation. During this period, children's right to health has mainly been demonstrated in studies from a healthcare context. All researchers, policymakers, health workers, and politicians should include children in all decisions that concern them, to increase their participation. As children's health is closely linked to their physical, social, and cognitive development there is a need for more studies exploring children's right to health in preschool and school contexts in which children spend their everyday life.

The UN Convention on the Rights of the Child (1989) asserts the right of every child to self-determination, dignity, respect, non-interference, and the right to make informed decisions. The provision of quality care in health services tailored to children's preferences means that health professionals have a responsibility to ensure children's rights, and that the child is encouraged and enabled to make his or her view known on issues that affect them. This paper will help illuminate and differentiate between a child perspective and the child's perspective in health care settings. The issues are supported with research which illustrates the different perspectives. Both perspectives are required to perceive and encounter children as equal human beings in child-centred health care settings.

Methodological issues when conducting research with children and adolescents

Maja Söderbäck, Marie Golsäter, Maria Harder,

CHILD Research Group, Sweden

This symposium will focus on methodological issues and challenges using different techniques in qualitative research when conducting research with children and adolescents in health care. The session will consist of three linked presentations that:

1. Provide experiences of using video technique in observing children’s expressions of actions.  
2. Provide experiences of using participatory methods such as drawings and pictures to encourage children to tell about their perceptions on a specific theme.
3. Provide experiences from focus group interviews with children and adolescents.

The concluding discussion will focus on methodological issues related to children´s competence to bodily and verbally express their wish, experiences, motivation and feelings, when using these techniques. Also, research findings from these techniques will be discussed. Furthermore, ethical considerations and the researchers’ interpretation of the children´s perspectives are issues demanding reflections.

i  The use of video technique in observing children’s expressions of actions  

Maja Söderbäck

School of Health, Care and Social welfare, Mälardalen University, Sweden

Maria Harder

School of Health, Care and Social welfare, Mälardalen University and Department of Women’s and Children’s Health, Karolinska Institutet, Sweden

Video technique is found to be useful in qualitative research when the interest is to explore young children’s expressions of actions in situations where they participate as actors with parents and health care professionals. Through this technique the whole situation and the child´s varying and detailed expressions are captured. Thus the use of video provides the opportunity to capture the child’s subjective perspective. The researcher’s role is to be objective and follow the child in the course of the situation without interference.

Further, the video technique allows the researcher to study a child’s expressions several times during the analysis, and to reflect and validate with co-researchers. However, the interpretation of the children's expressions of actions needs to be guided by the intention to understand the children’s perspectives.

This presentation will demonstrate issues related to the use of video technique when observing children three to five years of age during health visits in a Primary Child Health Care situation and in a care procedure involving venepuncture. Further, discussion concerning analysis of the gathered data with respect for children´s competence to bodily and verbally express their wish, experiences, motivation and feelings will be brought up.

1. ii.                  The use of drawings and pictures as participatory methods to encourage children to tell about their perceptions on a specific theme

Maria Harder

School of Health, Care and Social welfare, Mälardalen University and Department of Women’s and Children’s Health, Karolinska Institutet, Sweden

Maja Söderbäck

School of Health, Care and Social welfare, Mälardalen University, Sweden

The movement from doing research on children to do research with children within the health care area challenges researchers to use participatory methods. The use of drawings and pictures are such participatory methods which allow children to share their perceptions and experiences of a situation. Drawings and pictures are familiar from children’s every-day-lives and suit their competence. Furthermore, the use of drawings and pictures facilitate the interaction between the child and the researcher. To let children make drawings about a specific theme and tell about them announce the children as experts and that their perceptions and experiences are valuable. The use of pictures makes a theme well-defined for the children and will make it easier for them to associate and talk unconstrained. The combination of various participatory methods in one data-collection might contribute to detailed descriptions of children’s perceptions about a phenomenon. This presentation will demonstrate a combination of participatory methods which have contributed to grasp children’s perceptions of various situations as for example going through a vaccination. The presentation will further bring up methodological issues related to the use of participatory methods and the analysis of grasping children’s perceptions with respect to their competence.

1. iii.                The use of  focus group interviews with children and adolescents

Marie Golsäter

School of Health Sciences, Jönköping University, Sweden.

Karin Enskär

School of Health Sciences, Jönköping University, Sweden.

According the Convention on the Rights of the Child, children and adolescents have the right to be heard in matters concerning them. Focus group interviews is a useful way to voice children's and adolescent's perspectives. The interaction that occurs in a focus group can contribute to new dimensions of a topic from the participant’s perspective and contributes to the exploration of perspectives that might remain undetected in one to-one interviews.

Focus group interviews might also encourage children and adolescents to express their own view instead of answering in a way they believe the interviewer wants them to answer. One disadvantage could be that those not comfortable taking part in groups may choose not to participate or might have no chance to express their experiences.

This presentation will demonstrate the methodological issues revealed during focus group interviews with children and adolescents regarding their experiences of health and life style dialogues with the school nurse. Issues such as performing focus groups interviews with participants in various age groups, the size of the group and the use of mixed or unisexual groups will be brought up.

Background: School nurses in the school health services are assigned to promote health and participation among children when conducting health visits. Still, for children of foreign origin this promotion of participation might be hampered by challenges related to cultural diversity and language barriers. Therefore, knowledge needs to be developed regarding how these children’s participation can be promoted, to support them in sharing and describing matters important for their health. The aim was to investigate school nurses’ descriptions of promoting participation for children of foreign origin in health visits. Methods: A content analysis of 673 Swedish school nurses’ answers to eight open-ended questions regarding promotion of participation for children of foreign origin was conducted. The open-ended questions were part of a larger web-based cross-sectional survey distributed to school nurses in Sweden. Results: The results show that school nurses use three main approaches during the health visit: adjusting according to the child’s proficiency in Swedish and/or cultural or national background, adjusting according to the child’s individual needs, and doing the same for all children regardless of their origin. Yet, adjustments according to the child’s proficiency in Swedish and/or cultural or national background were the most common. Conclusions: By combining the approaches of adjusting, a child-centered care that contributes to children’s participation in health visits and equity in health could be provided. 

Background: Migration affects the health of children worldwide. Therefore, school nurses who encounter these children as part of their everyday practice need support from guidelines on how to promote the health of children who have migrated or whose parents have migrated. Yet knowledge regarding such content in guidelines of school nursing practice is sparse. Therefore, this study aims to investigate how municipal and regional guidelines and health questionnaires used in health visits in the Swedish school health services include factors related to migration that affect children's health.

Methods: A document analysis of municipal and regional guidelines and health questionnaires guiding school nurses' practice in health visits was conducted during the autumn of 2020. In total, 687 guidelines and health questionnaires were analyzed using deductive content analysis.

Results: The results show that municipal and regional guidelines and health questionnaires used in health visits in the Swedish school health services include content on many factors related to migration that affect children's health. Yet the content was limited, and none was found on factors related to discrimination based on ethnicity or origin.

Conclusion: Guidance related to promoting the health of children who have migrated or whose parents have migrated should include all factors affecting these children's health. Therefore, to strengthen school nurses' evidence-based practice, guideline development might be needed, although guidelines and health questionnaires exist and include content on many factors related to migration affecting the health of children in order to provide equitable healthcare for all children, regardless of country of origin.

The purpose of this study was to investigate associations between school nurses' self-assessed cultural competence in health visits with children of foreign origin and demographic variables, by using a cross-sectional design. A Web-based questionnaire assessing cultural competence and demographic variables was distributed to a nationally representative sample (n = 816) of school nurses in Sweden. Data were analyzed using regression analysis. School nurses assessed themselves as culturally aware and moderately culturally competent, but not as culturally knowledgeable, culturally skilled, or comfortable in cultural encounters. Cultural competence was related to education in cultural diversity, how often nurses encounter children of foreign origin, and nurses' country of origin. In total, these variables explained 23.6% of the variation in school nurses' cultural competence. Because school nurses regard themselves as moderately culturally competent, a foundation for promoting children's health on equal terms in school health care exists. However, education in cultural diversity combined with other additional strategies is needed to further strengthen school nurses' cultural knowledge, skills, and comfort level in encounters with children of foreign origin.

AimTo explore the experiences of health visits within the school health services from the perspective of adolescents with migration experiences.DesignA descriptive qualitative study.MethodsData were collected using focus groups and semi-structured individual interviews with adolescents with migration experiences aged 13-17 years old. Analysis was conducted using reflexive thematic analysis.ResultsThe results described adolescents reading the signs in the guided interaction between them and the school nurses. Reading the signs illustrated the adolescents' continuous interpretation of the interaction with the school nurse, and their decisions on how to respond throughout the health visit. These interpretations influenced the adolescents' shifting willingness to talk about their health and how they adapted to the space of participation provided by the school nurse. The interpretation also influenced their experiences of health visits as focusing on their health without making them feel singled out.ConclusionAlthough individual considerations might be warranted in health visits with adolescents with migration experiences, the results indicate that similarities in intrapersonal communication in various encounters between adolescents and health professionals might be greater than any differences. Healthcare encounters with adolescents with migration experiences might thus need to be conducted with an awareness that adolescents read the signs in the guided interaction and that similarities in this interaction are greater than any differences.

Background

Children in need of special support often display delays in time processing ability, affecting everyday functioning. MyTime is an intervention programme for systematic training of time processing ability. To support preschool children's development of time processing ability and everyday functioning, it is necessary to include their perspectives of the MyTime intervention programme. A previous study shows that MyTime is feasible with children in the preschool setting and shows positive effects on time processing ability for older children in special schools. Yet, there is a lack of knowledge regarding how preschool children experience the intervention programme and how they understand its meaning. The aim of this study was to explore the experiences and the meaning of using MyTime from the perspective of children with informal needs of special support (INS) 5–6 years of age in the preschool context.

Methods

To explore the children's perspectives, video-recorded interviews with 21 children were analysed hermeneutically. To facilitate the interview situation with the children in need of special support, the Talking Mats© was used. Both body and spoken languages were analysed.

Results

The results reveal children as active participants, willing to share their experiences of using the MyTime intervention in the preschool context. The conceptualization of the children's experiences and expressions uncovers their meaning of using the MyTime intervention as to know and to understand time by doing.

Conclusions

When children are given the opportunity to use concrete tools to understand and measure time, they experience themselves as active participants involved and engaged in the intervention. They reveal meaningful experiences to be able to manage time that facilitate their everyday functioning and participation in the preschool context.