Open AccessFacilitating implementation of an evidence-based method to assess the mental health of 3–5-year-old children at Child Health Clinics: A mixed-methods process evaluation
Author(s) -
Elisabet Fält,
Raziye Salari,
Helena Fabian,
Anna Sarkadi
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0234383
Subject(s) - mental health , strengths and difficulties questionnaire , outreach , descriptive statistics , medicine , nursing , population , psychology , data collection , medical education , family medicine , psychiatry , environmental health , statistics , mathematics , political science , law
Background A number of instruments for identifying mental health problems in children are available, but there is limited knowledge about how to successfully implement their use in routine practice. The Strengths and Difficulties Questionnaire (SDQ) is an instrument with sound psychometric properties. Because using multi-informant SDQs when assessing young children has been emphasized, parent- and preschool teacher reports on the SDQ were introduced at Child Health Clinics in a Swedish municipality. This paper aimed to describe a facilitation programme developed to support the introduction of SDQ in clinical practice and evaluate how nurses perceived the facilitation strategies used. Moreover, the dose (delivery) and reach (response rate and population coverage) of the questionnaires were assessed. Methods The mixed-methods process evaluation was guided by Moore et al.’s framework. Process data were excerpted from monitoring data, the trial database, research group documents, study materials, group interviews with nurses, and a survey on nurses’ opinions and experiences of the screening method and the implementation process. Data were analysed using descriptive statistics and qualitative content analysis. Results Facilitation strategies used included: educational meetings, educational outreach visits, newsletters, facilitative administrative support, and adaptations made in procedures and materials when required. Although nurses described a variety of barriers at the organisational and individual level, they were in favour of using the SDQ in clinical practice and emphasised the importance of the facilitation strategies used for its implementation. While dose levels (77–91%) indicated that nurses essentially delivered the intervention as intended, parental response rates remained between 54 and 63% and population coverage at around 50%, throughout the intervention period. Conclusion The facilitation program was perceived to support the implementation of the SDQ at the yearly check-ups in the child healthcare setting, but further efforts are required to reach all families.