Background
Methods
Study context
Description of involved sectors
Salut programme development and implementation process
Intervention | Antenatal care | Child health care | Dental service | Open pre-school |
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Motivational interviewing [32] |
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Collaboration between involved sectors |
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Parent meetings |
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Health counselling focusing on life habits, mental health, domestic violence1, parent-child attachment, psychosocial health and parent relationships |
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Edinburgh Postnatal Depression Scale (EPDS) screening [61] |
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Oral health screening at 12 months of age |
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"Mothers visit" at child age 8 months including screening for domestic violence |
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"Fathers visit" at child age 10 months with focus on fathers experiences of change in life situation |
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Questionnaires for health surveillance |
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Free dental health care visit for the pregnant woman and her partner |
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Activities to enhance early parent-child attachment, children's physical activity and linguistic development |
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Activities supporting parents to establish contacts with each other |
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Activities to promote healthy snacks/food and drinks |
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Participants
Sex female, n (%) | Age mean, years (range) | Work experience mean, years (range) | |
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Midwives | 5 (100) | 53 (41-64) | 24 (16-32) |
Child health nurses | 7 (100) | 57 (52-63) | 26 (13-38) |
Dental hygienists/dental nurses | 7 (100) | 39 (26-47) | 14 (05-29) |
Pre-school teachers | 4 (100) | 54 (48-58) | 31 (26-35) |
Data collection procedures
Data analysis
Trustworthiness
Ethics approval
Results
Perceived programme sustainability
This way of working is so well established so I know what to do.... I don't have to read the manuals frequently. (Dental hygienist)
FACTORS INFLUENCING SUSTAINABILITY | |||
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LEVEL | REQUIREMENTS | FACILITATORS | BARRIERS |
Innovation
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Development process | Involvement in development and small scale testing 1-4
Support from process consultants 1-4
Having time to develop strategies 1-4
| Time consuming and ineffective 1-4
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Content | Carefully designed work manuals 3
| Perceived as important 1-4
Easily integrated 1-4
Manuals essential tools 1-4
Clear programme branding 1-4
| Time consuming 1-4
Not suiting specific needs of immigrants 1,2,4
Difficulty with social and psychological problems 1,2
Found similar to approaches already present at the work place 1,2,4
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Individual
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Professionals | Own commitment and interest 1-4
| Own values coherent with programme's purpose and goals 1-4
| Lack of motivation 2,3,4
Programme goals found unrealistic 2
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Parents (Patients) | Positive attitudes to interventions 3,4
| New topics and questionnaires intrusive and extensive 1-3
Content of parent meetings unpopular 1,3
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Context
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Social | Regular meetings 1-4
Permanent programme organization 1-3
Information to new employees 1,3
Managerial responsibility and commitment1-4
| Regular meetings 1-4
Active managerial support 1-4
| Lack of managerial involvement or support 1-4
Lack of involvement or support from physicians or other colleagues 1-3
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Organizational | Programme integrated in action plans 1-3
Geographical proximity for collaborators 1-4
Sufficient time 1-3
Further establishment and spread of the programme 1-4
| Geographical proximity for collaborators 1-4
| Lack of time and resources 1-4
Lack of communication and agreement between programme management and local managers 2,3
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Economical and political | Incentives in line with programme intentions 3
| Conflicting incentives for performance 3
Threat of cutbacks 1-3
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Perceived facilitators, barriers, and requirements for programme sustainability
The innovation development process
At first, we had enormously high goals set that were unrealistic. They have been adjusted into smaller goals by us. I think, that is why we are here today. (Dental hygienist)
We were so tired of all those questions, about current status and how to proceed. At the same time we felt that we did not move forward, we were stuck at square one. (Open pre-school teacher)
We have built this on our own. It had empty spaces, lacked a basic programme, had nothing like this. It is ours, definitely ours. (Open pre-school teacher)
If you can learn to do a good job, then I think that will lead to success.... if you for a while have time to develop a good routine, then I think it will be sustainable. (Child health nurse)It does not take much more time if you have time to practice and introduce it as a part of your working methods. (Midwife)
The innovation content
It fits my way of thinking. In that way it has been easy. (Child health nurse)
Well-documented work manuals are important; it is essential that new employees, regardless of the place and profession, easily can get information on how we work. (Dental hygienist)
There are a lot of things that comes up to the surface. The hard thing is to know how to deal with it in a good way. (Midwife)
You just have to mention Salut when you call, then everybody knows why you are calling. Because everyone has heard of it. (Dental hygienist)
The individual professionals
I cannot say that it has been difficult... it has not been like that, but... I mean everything that is new. If you've been working as long as I have, you sometimes feel that, oh no, please, no more.... Do you understand? You know, something more to be put on your shoulders. (Child health nurse)
The Parents (Patients)
The clients experiences that there are too many questionnaires. Many questions and forms, they obviously get tired of it, which is understandable. (Dental hygienist)
The social context
When the programme is disseminated, I believe that coordinators are needed in all areas.... you really have to have some unifying persons, otherwise it will disappear. (Dental hygienist)It is always like, it is always a lot of enthusiasm in the beginning of a project, and then, you will fall back into old routines. I think it's necessary to stop and think, and come together in meetings and things like that. (Midwife)I thought it was fantastic to be there, and to benefit from other's knowledge, to learn new things I can use in my work. And, of course, I share my knowledge as well, and in that way I am part of the decision process. (Pre-school teacher)
It is important to have support from our leaders.... I think it is important to remind them in some way, for example to go to their meetings and to remind them now and then in between. I think that is important to keep the flame burning. (Midwife).The managers have a great responsibility in leading [leadership]. If they stop talking Salut, then I think Salut will die, actually, I think that's the fact. (Dental hygienist)The managers have not been present. They have not given the priority to this programme as they perhaps should have done, partly perhaps or because they relied on the project coordinator. They saw her as the spider of the web and the one who should spread the information. So they could withdraw themselves a bit. (Open pre-school teacher)
The organizational context
If you have a query it is so easy just to walk over there [to collaborators in other sectors] because we are so close. It's essential that it is easy. (Dental hygienist)
This extra work has been forced into our regular activities and working hours, and that is never good. You need extra time during the start up period in order to find your own solutions.... You basically need time to develop this. And this extra time was never given us. (Child health nurse)
The economic and political context
We are doing this now because we think it's fun and interesting. However, it will be difficult to involve others, because it is more important to have patients that generate money. This generates no money. (Dental hygienist)
This [The Salut programme] is unfortunately nothing that is given priority right now because of the threats of cutbacks.... These things are given the lowest priority under such circumstances, that's the way it is. (Child health nurse)