International Journal of Environmental Research and Public Health, 2022
School attendance is crucial for the development of a child. Sickness absence is the most common ... more School attendance is crucial for the development of a child. Sickness absence is the most common type of absenteeism and can be a red flag for underlying problems. To address sickness absence, the intervention Medical Advice for Sick-reported Students for Primary School (MASS-PS) was recently developed. It targets children at risk and is a school-based child and youth health care intervention. The present study is a process evaluation of the intervention. MASS-PS was implemented and evaluated in 29 schools in the West-Brabant region of the Netherlands, during three school years (2017–2020). Attendance coordinators (ACs) from the different schools were interviewed in six focus group interviews as well as in over 200 individual conversations, of which logbooks were kept. Content analysis was used based on a framework of implementation elements. During the first year of the study, the uptake was low. Changes were made by the project group to improve the uptake. The ACs generally consid...
Neighbourhood socioeconomic disadvantage and social capital have been associated with adolescent ... more Neighbourhood socioeconomic disadvantage and social capital have been associated with adolescent well-being, but the majority of studies were cross-sectional, and the time window over which the neighbourhood may impact on development is unknown. Therefore, the contribution of the neighbourhood environment to adolescents' quality of life and the course of these effects during the period of transition from childhood to early adolescence was examined. A cohort of adolescents living in Maastricht (The Netherlands), with a mean age of 11.2 years at baseline and of 13.5 years at follow-up was followed. Adolescents who responded both at baseline and at follow-up were included in the analysis (n = 475). Multilevel regression analyses estimated neighbourhood effects while controlling for individual-level effects. Neighbourhood-level socioeconomic and social capital variables, individual-level confounders, and baseline values of the outcome measures were included in the models. None of th...
Neighbourhood objective socio-economic indicators and community-reported subjective measures of s... more Neighbourhood objective socio-economic indicators and community-reported subjective measures of social capital were examined in relation to children's health-related quality of life in the Netherlands. Three different data-sources were used: (1) objective neighbourhood socio-economic indicators, (2) subjective neighbourhood data on social capital, and (3) individual data of a family cohort study, including questions on children's health-related quality of life, and family socio-economic status. Multilevel analyses were conducted using both neighbourhood level and individual level data. Neighbourhood socio-economic status and social capital were associated. Measures of socio-economic deprivation and social capital were both non-specifically associated with children's general health and satisfaction, independent of possible individual-level confounders. However, children's mental health and behaviour were specifically associated with one aspect of social capital, the degree of informal social control in the neighbourhood.
ABSTRACT AimMany child-onset mental health diseases have strong epigenetic links, but no genetic ... more ABSTRACT AimMany child-onset mental health diseases have strong epigenetic links, but no genetic tests are yet available for them. Family history (FH) information in paediatric primary care should be promoted to assist decision-making. This study aims to explore the extent of the real-life use of the FH for mental health issues by paediatric physicians. Methods The medical records of 474 children (31.5% female), referred to the specialised mental health care services in the Netherlands, were used. Data were retrospectively extracted from the medical files, according to a list of 15 criteria regarding the use of FH information. ResultsThe FH was explored in the form of a diagnosis and was presented at birth in 88.3% of cases and in half of the files at 5 years. Negative FH and the age of relatives at the time of diagnosis were virtually not mentioned. FH was present in more reports from the specialists, than in referral letters. Conclusion Despite the high importance of FH for primary paediatric care, this study shows that FH is underreported in practice. We should promote structural FH taking to increase how often it is used to treat children who do not meet criteria for definitive diagnosis.
Introduction: Lower urinary tract symptoms (LUTS) and gastrointestinal (GI) problems are common i... more Introduction: Lower urinary tract symptoms (LUTS) and gastrointestinal (GI) problems are common in Duchenne muscular dystrophy (DMD), but not systematically assessed in regular care. We aimed to determine the prevalence of bladder and bowel dysfunction (BBD) in DMD patients compared with healthy controls (HC). Methods: The Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ) based on the International Rome III criteria and the International Children’s Continence Society was filled out by 57 DMD patients and 56 HC. Additionally, possible associations of BBD with, for example, medication use or quality of life were evaluated in an additional questionnaire developed by experts. Results: In 74% of patients versus 56% of HC ≥ 1 LUTS (n.s.) were reported, 68% of patients versus 39% of HC reported ≥1 bowel symptom (p = 0.002) and 53% of patients versus 30% of HC reported combined LUTS and bowel symptoms (p = 0.019). A negative impact of BBD on daily life functioning was reported b...
Background Within the Dutch Child Health Care (CHC), an online tool (360° CHILD-profile) is desig... more Background Within the Dutch Child Health Care (CHC), an online tool (360° CHILD-profile) is designed to enhance prevention and transformation toward personalized health care. From a personalized preventive perspective, it is of fundamental importance to timely identify children with emerging health problems interrelated to multiple health determinants. While digitalization of children’s health data is now realized, the accessibility of data remains a major challenge for CHC professionals, let alone for parents/youth. Therefore, the idea was initiated from CHC practice to develop a novel approach to make relevant information accessible at a glance. Objective This paper describes the stepwise development of a dashboard, as an example of using a design model to achieve visualization of a comprehensive overview of theoretically structured health data. Methods Developmental process is based on the nested design model with involvement of relevant stakeholders in a real-life context. This ...
Family care-givers are the backbone of the long-term support system for care receivers at home. C... more Family care-givers are the backbone of the long-term support system for care receivers at home. Care for stroke survivors after rehabilitation primarily rests on the shoulders of family members, often of older age themselves. We report the outcomes of a new complex support programme, the Care-givers’ Guide, on both individual and system levels. Psycho-social support and personalised information were the main ingredients of this intervention. A two-level multi-methodological approach was needed, with two concurrent interconnected studies. Family care-givers reflected on outcomes at an individual level in a quant-QUAL study with a pre–post quantitative questionnaire and a post-intervention qualitative semi-structured interview. Practitioners participated in a QUAL-QUAL study ex post interview, reflecting on the outcomes on the care-givers and on their own stroke care system. Individual family care-givers showed an increase in health literacy and level of psycho-social health. Qualitat...
We examined how gut feelings of child health care physicians’ (CHCPs) contribute to the developme... more We examined how gut feelings of child health care physicians’ (CHCPs) contribute to the development of a suspicion of child abuse, how they act upon this suspicion and what barriers they experience in their management. To gain insight into the youth health care chain, we compared the diagnostic reasoning and management regarding this issue by CHCPs and family physicians (FPs).
A 3600Child-profile, with theoretically ordered, integral child-information visualized in one ima... more A 3600Child-profile, with theoretically ordered, integral child-information visualized in one image, is designed by the Dutch preventive Child and Youth Health Care (CYHC). The introduction of this new data/information carrier gives an important incentive to enhance a transformation towards personalized health care for children and adolescents by supporting the complex medical thought process of CYHCmedical doctors (MD's). This information tool aims to effectively estimate child's functioning, detect emerging health problems and inform parents and caregivers.This pilot study evaluated aspects of inter- and intra-rater reliability and concurrent validity of the 3600Child-profile when used by MD's to estimate functioning and needed intervention of 4-year-old children. After the development process, in January 2015, 3600Child-profiles (n = 26) were assessed by MD's, in the Netherlands. Each MD assessed two Childprofiles twice and was matched to another MD receiving exactly the same two profiles. The paired scores and rater's scores of both time-points were compared. Rater's scores also were compared with the 26 reference tests scores.Reliability results showed Intraclass correlation coefficients between 0.71 and 0.82 (overall functioning), Cohen's kappa's between 0.61 and 0.80 (psychosocial functioning) and 0.46–0.47 (needed intervention). Validity results showed a Spearman's correlation coefficient of 0.78 (overall functioning), Cohen's kappa's of 0.43 and 0.77 (psychosocial functioning) and 0.52 (needed intervention).In conclusion, in some domains, acceptable results regarding reliability and validity are found for the visualization of integral childinformation used by CYHC-MD's to assess child-functioning after only a short training. The 3600Child-profile's value on tracking change in functioning and decision-making on intervention needs further exploration.
BACKGROUND Stakeholders are important contributors in the implementation of a complex public heal... more BACKGROUND Stakeholders are important contributors in the implementation of a complex public health intervention. During the development phase of an implementation, alongside careful design of its components and investing in the exploration of the dynamic multi-stakeholder stroke rehabilitation setting, it is essential to assess possible implementation risks. Systematic stakeholder and risk analyses can guide the exploration process and enable teams involved in complex interventions to develop context-tailored implementation management instruments. PURPOSE To develop instruments that facilitate the implementation of the complex stroke caregiver intervention project in the real-life support system. METHODS Systematic stakeholder and risk analyses were conducted composing five activities. Project stakeholders were identified, classified and assessed using a top-down approach, while implementation risks were identified and assessed by applying a bottom-up approach. Data were collected through interviews and focus groups. RESULTS Based on the knowledge provided by the stakeholders, two context-tailored implementation management instruments were designed with a top-down approach: (1) a comprehensive 'stakeholder-risk atlas' providing individual stakeholder information, such as role, access, contribution, power and interest, expectations, perceived risks and specific engagement activities and (2) an overall 'project implementation strategy' concentrating on communication, transparency, network building and professionalism. CONCLUSION Complex interventions will benefit from early and comprehensive stakeholder and risk analyses. The early involvement of stakeholders, with their insightful knowledge, enables the research team to develop context-tailored implementation management instruments. Instruments will support the team during implementation and may impact positively on the outcome of the intervention. Knowledge can be obtained by combining top-down and bottom-up working approaches.
The Dutch Child Index is a nationwide information system (IS) designed to alert professionals abo... more The Dutch Child Index is a nationwide information system (IS) designed to alert professionals about each other's involvedness with at-risk children, enabling iden- tification of individual at-risk children, improvement of multidisciplinary collaboration and timely interventions. In this paper, we study the infrastructural work and complex - ities engaged in making the collaborative system of the Child Index function in real life and in care situations. We use the information infrastructure perspective as an analyti - cal lens and describe the infrastructural work that is performed to make the Child Index become part of actual practices. We also identify flexibility, heterogeneity and the con - nection to existing platforms as difficulties participants have had while performing infra - structural work. The paper makes two main contributions. First, it provides an in-depth empirical analysis of this specific collaborative and preventive infrastructure. Second, based on this empiri...
This article studies the construction of children at risk in the introduction process of a novel ... more This article studies the construction of children at risk in the introduction process of a novel ICT system in Dutch child welfare, the Child Index. This early warning electronic information system enables early reporting of children at risk to stimulate multidisciplinary collaboration among the different professionals involved with a particular child. We followed the introduction of the Child Index in practice. Our empirical analysis provides insight into the co-production of this ICT system and risk in child welfare practices. The analysis shows that the interaction between local and national, and disciplinary and organisational differences induces various constructions of risk, making the decision to signal and the act of signalling risk complex and the status of a signalled risk vague. Moreover, the analysis illustrates that the Child Index's goal of early signals for all children at risk does not fit professionals' daily practices and highlights the need to discuss whether the risk signalling ambitions of the Child Index are not a larger risk to children than the risks that are being targeted.
International Journal of Environmental Research and Public Health, 2022
School attendance is crucial for the development of a child. Sickness absence is the most common ... more School attendance is crucial for the development of a child. Sickness absence is the most common type of absenteeism and can be a red flag for underlying problems. To address sickness absence, the intervention Medical Advice for Sick-reported Students for Primary School (MASS-PS) was recently developed. It targets children at risk and is a school-based child and youth health care intervention. The present study is a process evaluation of the intervention. MASS-PS was implemented and evaluated in 29 schools in the West-Brabant region of the Netherlands, during three school years (2017–2020). Attendance coordinators (ACs) from the different schools were interviewed in six focus group interviews as well as in over 200 individual conversations, of which logbooks were kept. Content analysis was used based on a framework of implementation elements. During the first year of the study, the uptake was low. Changes were made by the project group to improve the uptake. The ACs generally consid...
Neighbourhood socioeconomic disadvantage and social capital have been associated with adolescent ... more Neighbourhood socioeconomic disadvantage and social capital have been associated with adolescent well-being, but the majority of studies were cross-sectional, and the time window over which the neighbourhood may impact on development is unknown. Therefore, the contribution of the neighbourhood environment to adolescents' quality of life and the course of these effects during the period of transition from childhood to early adolescence was examined. A cohort of adolescents living in Maastricht (The Netherlands), with a mean age of 11.2 years at baseline and of 13.5 years at follow-up was followed. Adolescents who responded both at baseline and at follow-up were included in the analysis (n = 475). Multilevel regression analyses estimated neighbourhood effects while controlling for individual-level effects. Neighbourhood-level socioeconomic and social capital variables, individual-level confounders, and baseline values of the outcome measures were included in the models. None of th...
Neighbourhood objective socio-economic indicators and community-reported subjective measures of s... more Neighbourhood objective socio-economic indicators and community-reported subjective measures of social capital were examined in relation to children's health-related quality of life in the Netherlands. Three different data-sources were used: (1) objective neighbourhood socio-economic indicators, (2) subjective neighbourhood data on social capital, and (3) individual data of a family cohort study, including questions on children's health-related quality of life, and family socio-economic status. Multilevel analyses were conducted using both neighbourhood level and individual level data. Neighbourhood socio-economic status and social capital were associated. Measures of socio-economic deprivation and social capital were both non-specifically associated with children's general health and satisfaction, independent of possible individual-level confounders. However, children's mental health and behaviour were specifically associated with one aspect of social capital, the degree of informal social control in the neighbourhood.
ABSTRACT AimMany child-onset mental health diseases have strong epigenetic links, but no genetic ... more ABSTRACT AimMany child-onset mental health diseases have strong epigenetic links, but no genetic tests are yet available for them. Family history (FH) information in paediatric primary care should be promoted to assist decision-making. This study aims to explore the extent of the real-life use of the FH for mental health issues by paediatric physicians. Methods The medical records of 474 children (31.5% female), referred to the specialised mental health care services in the Netherlands, were used. Data were retrospectively extracted from the medical files, according to a list of 15 criteria regarding the use of FH information. ResultsThe FH was explored in the form of a diagnosis and was presented at birth in 88.3% of cases and in half of the files at 5 years. Negative FH and the age of relatives at the time of diagnosis were virtually not mentioned. FH was present in more reports from the specialists, than in referral letters. Conclusion Despite the high importance of FH for primary paediatric care, this study shows that FH is underreported in practice. We should promote structural FH taking to increase how often it is used to treat children who do not meet criteria for definitive diagnosis.
Introduction: Lower urinary tract symptoms (LUTS) and gastrointestinal (GI) problems are common i... more Introduction: Lower urinary tract symptoms (LUTS) and gastrointestinal (GI) problems are common in Duchenne muscular dystrophy (DMD), but not systematically assessed in regular care. We aimed to determine the prevalence of bladder and bowel dysfunction (BBD) in DMD patients compared with healthy controls (HC). Methods: The Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ) based on the International Rome III criteria and the International Children’s Continence Society was filled out by 57 DMD patients and 56 HC. Additionally, possible associations of BBD with, for example, medication use or quality of life were evaluated in an additional questionnaire developed by experts. Results: In 74% of patients versus 56% of HC ≥ 1 LUTS (n.s.) were reported, 68% of patients versus 39% of HC reported ≥1 bowel symptom (p = 0.002) and 53% of patients versus 30% of HC reported combined LUTS and bowel symptoms (p = 0.019). A negative impact of BBD on daily life functioning was reported b...
Background Within the Dutch Child Health Care (CHC), an online tool (360° CHILD-profile) is desig... more Background Within the Dutch Child Health Care (CHC), an online tool (360° CHILD-profile) is designed to enhance prevention and transformation toward personalized health care. From a personalized preventive perspective, it is of fundamental importance to timely identify children with emerging health problems interrelated to multiple health determinants. While digitalization of children’s health data is now realized, the accessibility of data remains a major challenge for CHC professionals, let alone for parents/youth. Therefore, the idea was initiated from CHC practice to develop a novel approach to make relevant information accessible at a glance. Objective This paper describes the stepwise development of a dashboard, as an example of using a design model to achieve visualization of a comprehensive overview of theoretically structured health data. Methods Developmental process is based on the nested design model with involvement of relevant stakeholders in a real-life context. This ...
Family care-givers are the backbone of the long-term support system for care receivers at home. C... more Family care-givers are the backbone of the long-term support system for care receivers at home. Care for stroke survivors after rehabilitation primarily rests on the shoulders of family members, often of older age themselves. We report the outcomes of a new complex support programme, the Care-givers’ Guide, on both individual and system levels. Psycho-social support and personalised information were the main ingredients of this intervention. A two-level multi-methodological approach was needed, with two concurrent interconnected studies. Family care-givers reflected on outcomes at an individual level in a quant-QUAL study with a pre–post quantitative questionnaire and a post-intervention qualitative semi-structured interview. Practitioners participated in a QUAL-QUAL study ex post interview, reflecting on the outcomes on the care-givers and on their own stroke care system. Individual family care-givers showed an increase in health literacy and level of psycho-social health. Qualitat...
We examined how gut feelings of child health care physicians’ (CHCPs) contribute to the developme... more We examined how gut feelings of child health care physicians’ (CHCPs) contribute to the development of a suspicion of child abuse, how they act upon this suspicion and what barriers they experience in their management. To gain insight into the youth health care chain, we compared the diagnostic reasoning and management regarding this issue by CHCPs and family physicians (FPs).
A 3600Child-profile, with theoretically ordered, integral child-information visualized in one ima... more A 3600Child-profile, with theoretically ordered, integral child-information visualized in one image, is designed by the Dutch preventive Child and Youth Health Care (CYHC). The introduction of this new data/information carrier gives an important incentive to enhance a transformation towards personalized health care for children and adolescents by supporting the complex medical thought process of CYHCmedical doctors (MD's). This information tool aims to effectively estimate child's functioning, detect emerging health problems and inform parents and caregivers.This pilot study evaluated aspects of inter- and intra-rater reliability and concurrent validity of the 3600Child-profile when used by MD's to estimate functioning and needed intervention of 4-year-old children. After the development process, in January 2015, 3600Child-profiles (n = 26) were assessed by MD's, in the Netherlands. Each MD assessed two Childprofiles twice and was matched to another MD receiving exactly the same two profiles. The paired scores and rater's scores of both time-points were compared. Rater's scores also were compared with the 26 reference tests scores.Reliability results showed Intraclass correlation coefficients between 0.71 and 0.82 (overall functioning), Cohen's kappa's between 0.61 and 0.80 (psychosocial functioning) and 0.46–0.47 (needed intervention). Validity results showed a Spearman's correlation coefficient of 0.78 (overall functioning), Cohen's kappa's of 0.43 and 0.77 (psychosocial functioning) and 0.52 (needed intervention).In conclusion, in some domains, acceptable results regarding reliability and validity are found for the visualization of integral childinformation used by CYHC-MD's to assess child-functioning after only a short training. The 3600Child-profile's value on tracking change in functioning and decision-making on intervention needs further exploration.
BACKGROUND Stakeholders are important contributors in the implementation of a complex public heal... more BACKGROUND Stakeholders are important contributors in the implementation of a complex public health intervention. During the development phase of an implementation, alongside careful design of its components and investing in the exploration of the dynamic multi-stakeholder stroke rehabilitation setting, it is essential to assess possible implementation risks. Systematic stakeholder and risk analyses can guide the exploration process and enable teams involved in complex interventions to develop context-tailored implementation management instruments. PURPOSE To develop instruments that facilitate the implementation of the complex stroke caregiver intervention project in the real-life support system. METHODS Systematic stakeholder and risk analyses were conducted composing five activities. Project stakeholders were identified, classified and assessed using a top-down approach, while implementation risks were identified and assessed by applying a bottom-up approach. Data were collected through interviews and focus groups. RESULTS Based on the knowledge provided by the stakeholders, two context-tailored implementation management instruments were designed with a top-down approach: (1) a comprehensive 'stakeholder-risk atlas' providing individual stakeholder information, such as role, access, contribution, power and interest, expectations, perceived risks and specific engagement activities and (2) an overall 'project implementation strategy' concentrating on communication, transparency, network building and professionalism. CONCLUSION Complex interventions will benefit from early and comprehensive stakeholder and risk analyses. The early involvement of stakeholders, with their insightful knowledge, enables the research team to develop context-tailored implementation management instruments. Instruments will support the team during implementation and may impact positively on the outcome of the intervention. Knowledge can be obtained by combining top-down and bottom-up working approaches.
The Dutch Child Index is a nationwide information system (IS) designed to alert professionals abo... more The Dutch Child Index is a nationwide information system (IS) designed to alert professionals about each other's involvedness with at-risk children, enabling iden- tification of individual at-risk children, improvement of multidisciplinary collaboration and timely interventions. In this paper, we study the infrastructural work and complex - ities engaged in making the collaborative system of the Child Index function in real life and in care situations. We use the information infrastructure perspective as an analyti - cal lens and describe the infrastructural work that is performed to make the Child Index become part of actual practices. We also identify flexibility, heterogeneity and the con - nection to existing platforms as difficulties participants have had while performing infra - structural work. The paper makes two main contributions. First, it provides an in-depth empirical analysis of this specific collaborative and preventive infrastructure. Second, based on this empiri...
This article studies the construction of children at risk in the introduction process of a novel ... more This article studies the construction of children at risk in the introduction process of a novel ICT system in Dutch child welfare, the Child Index. This early warning electronic information system enables early reporting of children at risk to stimulate multidisciplinary collaboration among the different professionals involved with a particular child. We followed the introduction of the Child Index in practice. Our empirical analysis provides insight into the co-production of this ICT system and risk in child welfare practices. The analysis shows that the interaction between local and national, and disciplinary and organisational differences induces various constructions of risk, making the decision to signal and the act of signalling risk complex and the status of a signalled risk vague. Moreover, the analysis illustrates that the Child Index's goal of early signals for all children at risk does not fit professionals' daily practices and highlights the need to discuss whether the risk signalling ambitions of the Child Index are not a larger risk to children than the risks that are being targeted.
Uploads