Background
Method
Aim
Study design
Setting
Data collection
Characteristics of participants
No | Sexa | Age (years) | Total experience (years) | Experience as GP (years) | Jobb | Clinic |
---|---|---|---|---|---|---|
1 | F | 60–69 | 20–29 | 20–29 | GP | Solo (collabc) |
2 | M | 40–49 | 10–19 | 0–9 | GP | Partnership |
3 | F | 30–39 | 10–19 | 0–9 | GP | Partnership |
4 | F | 60–69 | 30–39 | 20–29 | GP | Solo (collabc) |
4 | F | 40–49 | 10–19 | MW | Solo (collabc) | |
5 | F | 50–59 | 30–39 | 20–29 | GP | Partnership |
6 | F | 50–59 | 20–29 | 10–19 | GP | Partnership |
7 | F | 40–49 | 10–19 | 0–9 | GP | Partnership |
8 | F | 50–59 | 20–29 | 20–29 | GP | Solo (collabc) |
9 | F | 30–39 | 0–9 | MW | Solod | |
10 | F | 40–49 | 0–9 | MW | Partnership | |
11 | F | 40–49 | 10–19 | MW | Partnership | |
12 | F | 40–49 | 10–19 | 0–9 | GP | Partnership |
Mean | 53 | 20 | 14 |
Data analysis
Results
Coherence: clinicians accepted the idea of increasing psychosocial focus in developmental assessments
Importance of developmental assessments
Interest in psychosocial aspects
“… you have not really revised the child health examinations since the 60s and the purpose of them, and back then there was high child mortality, and that is certainly not the case anymore. Then, how can we use these child health examinations?” – Midwife 9
Cognitive participation: it was novel for clinicians to ask families systematically about psychosocial factors
Relevance of the standardised child records
“... if the parents split up or something bigger happens, then it’s really important. And I have learned over the years that it is certainly not everyone who opens up about it.” – GP 8
Comparison to previous practice
“Something like social resources for example – it is new to ask about this. Relationships with grandparents is a new thing to ask about and then I have probably not asked so systematically about mental wellbeing.” – GP 6
Collective action: clinicians integrated the new practice in various ways
History taking
“You don’t ask if grandparents are present (laughs), are your siblings there and all those family relations. I asked about that many years ago. I already know that.” – GP 1
“I think it makes a lot of sense to go forward systematically, so you don’t forget or overlook anything.” – Midwife 10
“Well, there is something about those family relations which has been made clearer, where I wouldn’t have caught it before [prior to using the child records]” – Midwife 11
“… they [the parents] only answer regarding how things are with the baby. So [shows tunnel vision with her hands] that is what you get, if you ask such an open question, you get answers to how the baby has slept last night or how much it has vomited… you very rarely get to know anything about how mom actually feels herself.” – GP 3
“These are some silly questions and it’s hard to ask them. We are located in an area where there are many well-functioning people. It’s not a socially burdened area.” – GP 5
“… having to ask, and then there will be a lot of no’s. It makes it a little easier to touch lightly on some things if there are a lot of no’s… it’s nice enough that it’s very specified, but… you may not focus on the one thing that matters the most.” – GP 2
Using the parent–child interaction assessment
“I actually think it has been really good, because it can be very easy to just say: “well, it’s all fine”, whereas here I have really noticed it.” – Midwife 10
“It actually supported me… It has become something I have implemented in my head when I observe a mother and a child.” – GP 8
“When the little one starts to cry… she looks away and: “I just don’t know what to do, when he does that.” And then she can ignore him, and then the other one (parent) takes over” – Midwife 9
Changes in work-flow
“… I think it has given a different presence – a different focus on wellbeing, both on mother and child – especially on the parents.” – GP 3
Reflective monitoring: clinicians gained increased psychosocial focus from using the standardised child records but they also experienced barriers when using them
Structured approach to developmental assessments
“It was definitely an advantage to ask about their network and living conditions and all these things, which were actually specified.” – Midwife 9
“I don’t think you can make anything standardised for every clinic. The old solo practitioner, who has to change the approach he had for the last 30 years, compared to a newly educated young female [doctor] who had just become a mother herself, I think they do things differently.” – GP 7
Target groups
New vocabulary
“I could have used the words for what I thought was missing [e.g. in the parent child- relationship]. Sometimes you just can’t see what it is – where it is you don’t feel the parents hear or see the child. I have got words for that now. I just think those were the words I was missing back then to be able to describe it.” – GP 7
Time frames
Sensitive topics
“I think that can also be difficult, because it’s hard to criticise a mother who… does her best, right? And you have to be careful how you do it so that you still have their trust and they don’t feel like a bad mother, right?” – Midwife 11
Handling psychosocial issues
“… you’re also a pastoral carer when you’re a GP. You’re not just a doctor…” – GP 1
Legal concerns
“Well, you can say that a medical record follows you for your whole life and similarly in the context of insurance... It must be accurate, but you must be careful not to write anything that could harm the patient in the long run.” – GP 6