Background
Mandatory | Non-mandatory |
---|---|
Height | Discuss eating habits |
Weight | Discuss physical activity |
Eyesight | Speech and language development |
Hearing | Fine motor skills |
Oral health | Gross motor skills |
Question toilet habits | Behaviour and mood |
Note allergies | Other examinations as necessary |
DOMAINS | |
---|---|
Knowledge | Memory, Attention and Decision processes |
Skills | Environmental Context and Resources |
Social/professional role and identity | Social Influences |
Beliefs about capabilities | Emotion |
Beliefs about consequences | Behavioural Regulation |
Motivation and goals | Nature of the Behaviours |
Method
Design
Sample
Procedure
Theoretical domains | Examples of interview prompts |
---|---|
Knowledge | Do you know about the mandatory and non-mandatory components of HKCs? Do you know about the RACGP guidelines for child preventive health? |
Skills | How have you learned how to do a HKC? Have you had any training for HKCs? |
Which components of the HKC do you perform? Are there any specific areas of difficulty? | |
One of the non-mandatory components is questioning the social and emotional behaviour. Do you ask about that? | |
Can you assess the social and emotional well-being of a three-year-old? | |
What do you think about measuring children and calculating BMI? | |
Social/professional role | Who do you think should be doing HKCs? |
How do they fit with the checks done by MCHNs? | |
Do you think general practitioners have a role in preventive health in general? | |
Why did you set up HKCs in your practice? | |
Beliefs about capabilities | How good are we at picking up problems in young children? |
How easy or difficult is it to do a HKC? | |
Do you think that you’ve got the skills (to do a HKC)? | |
Do you fear that you might miss something? How confident are you that you can pick up a problem? | |
How confident are you with the assessment of social and emotional wellbeing | |
Beliefs about consequences | Do you think HKCs are worthwhile? Do you think they should be scrapped? |
In your experience of doing health checks with this age group, did you come across problems in your population? | |
What do you think about the evidence base behind the HKC? | |
How do you think parents view the HKC? Has anyone refused a check? | |
Motivation and goals | Why do you do HKCs? Why don’t you do HKCs? |
Memory, attention and decision processes | Is performing a HKC something you usually do? |
Do you use any prompts? | |
Has anyone decided NOT to do a HKC? | |
Environmental context and resources | Do you have any systems in place to run a HKC? |
Do you have the equipment? What do you use to help with a HKC? | |
Is anyone using any questionnaires or tools with a Healthy Kids Check? | |
Is there anything specific about WHERE you practice-your population group? | |
Social influences | Has anyone used any reminders or invitations for HKCs or do you just wait for people to ask? |
What do you think about the policy change that links the HKC with the Family Tax Benefits? | |
Emotion | How do you feel about health assessments with children? Does it give you any particular feelings or emotions? |
Behavioural regulation | Are there procedures or ways of working that encourage you to do HKCs? |
Nature of the behaviours | What do you currently do about HKCs |
What about weighing an overweight child? How do you approach an overweight child? |
Name and description of area of Melbourne | Participant numbers in GP focus groups (Total =22) | Participant numbers in practice nurse focus groups (Total =18) (all female) |
---|---|---|
Bayside upper socio-economic | 6 (3 female 3 male) | 6 |
Dandenong lower socio-economic Culturally and linguistically diverse | 9 + 1 practice nurse (6 female 4 male) | 6 |
Westgate lower socio-economic | 7 (4 female 3 male) | 5 |
Analysis
Code assigned directly to transcripts from focus groups | Themes from TDF | COM-B system |
---|---|---|
Rationale for doing HKCs** | Knowledge | Psychological CAPABILITY |
Memory-remembering to do HKCs/preventive | Memory, attention and decision processes | |
Growth and weight component of HKC** | ||
Systems and prompts** | Behavioural regulation | |
Structure-logistics (how the clinic is run)*** | ||
Tax incentive issues prompting HKC | ||
Standardisation of HKCs or components within | ||
Medicare and item numbers | ||
Immunisation or vaccination issues | ||
Financial barriers (for practitioners) | ||
Dental component of HKC** | Skills | Physical CAPABILITY |
Eye or vision component of HKC** | ||
Hearing component of HKC** | ||
Child support network, e.g., childcare & kinder** | Social influences | Social OPPORTUNITY |
Parent concern | ||
Role of MCHN | ||
Population screening | ||
Socio-cultural issues | ||
Resource allocation as equity/ethical concern** | ||
Systems and prompts for HKCs** | Environmental context and resources | Physical OPPORTUNITY |
Structure-opportunistic (appointments)** | ||
Structure-logistics (how the clinic is run)*** | ||
Structure- IT | ||
Space and resources including ‘Purple Book’ | ||
Time barrier | ||
Dental component of HKC** | Beliefs about capabilities | MOTIVATION- Reflective |
Eye or vision component of HKC** | ||
Social & emotional health component of HKC*** | ||
GP knowledge and skills** | ||
PN attitude and feelings** | ||
PN knowledge and skills | ||
Role of the PN** | ||
PN attitude and feelings** | Professional role and identity | |
Role of the PN** | ||
GP attitude and feelings | ||
Role of GP | ||
Social & emotional health component of HKC*** | ||
Child support network, e.g., childcare & kinder** | ||
Motivation (to do HKC or preventive care) | Motivation and goals | |
Preventive healthcare | ||
Rationale for doing HKCs** | Beliefs about consequences | |
Outcomes from HKCs | ||
Early intervention | ||
Bureaucracy and ‘red tape’ barriers | ||
Social & emotional health component of HKC*** | ||
Growth and weight component of HKC** | ||
Resource allocation as equity/ethical concern** | MOTIVATION-Automatic | |
Hearing component of HKC** | Nature of behaviours | Not included in COM-B model but each code is a duplicate |
GP knowledge and skills** | ||
Structure-logistics (how the clinic is run)*** | ||
Structure-opportunistic (appointments)** |
Results
Evidence | TDF | COM-B | Proposed intervention |
---|---|---|---|
Capability | |||
GPs did not always know how to assess aspects of development | Knowledge | Capability-Psychological | Education and training which incorporates: |
PNs did not know how to do HKCs (until they had received training) | Knowledge about “Early Intervention” | ||
GPs did not always remember how to assess overall development | Memory | Physical examination techniques | |
GPs conducting HKCs were uncertain about which tests to use and how to do them | Physical skills | Capability-Physical | Structured developmental assessment and evidence behind this |
Interpersonal skills training | |||
PNs wanted training on skills required for HKCs | Tools appropriate to primary care | ||
PNs did not know how to manage parent reactions to possibility of abnormality in child’s development. | Interpersonal skills | Capability-Psychological | |
Variable quality of HKCs | Behavioural regulation | ||
Opportunity
| |||
Equipment barriers | Environmental context and resources | Physical opportunity | Funding for equipment and tools, including information technology |
Supportive health promotion brochures | |||
Space in clinic to accommodate the HKC examinations | Provision of health promotion literature | ||
Medical contact with children especially vaccinations | Social influences | Social opportunity | Education and training which incorporates: |
Practice structure | |||
Employing a PN | Office systems including recall and reminder | ||
Having staff responsible for managing a recall system | Tools appropriate for use in general practice (time saving) | ||
Having a “HKC Champion” | |||
The professional mix in the practice | |||
Competing interests of practice population healthcare needs | |||
Practitioners had insufficient time | |||
“Healthy Start for School”-Tax incentive to complete HKC | Strengthen government support for delivery of early childhood intervention across services | ||
Increase in Medicare rebate | |||
Belief that general practice competes with other service providers to provide HKCs | |||
Motivation
| |||
Belief that MCHNs have ownership and expertise in preventive healthcare for young children | Professional role and identity | Reflective motivation | Education and training which address capability and professional roles with task delegation |
GPs find process tedious and place HKCs low priority | |||
Alternative model of developmental assessment with early childhood educators playing primary role | |||
Developing the role of the PN in Australian general practice | Professional role and identity & Beliefs about capabilities | ||
PNs expressed low levels of self-confidence with some of the components of the HKC | |||
PNs preferred clear boundaries when delivering HKCs | |||
PN personal drive for professional development | Goals, intentions and motivation & Positive beliefs about consequences | Opportunity to build capacity in early childhood development involving other professionals | |
HKCs used by some practitioners to develop professional expertise | |||
PNs more confident about their abilities were more satisfied with outcomes | Centralisation and dissemination of information about community resources | ||
Outcomes and referral pathways are important to practitioners beliefs | |||
GPs expressed low confidence with evidence behind HKCs | Negative beliefs about consequences | ||
Belief that timing of HKC is too late for early intervention |