Mid Sweden University

ObjectiveThis study aimed to translate and preliminarily evaluate the Swedish translation of the Parental Stress Scale.BackgroundParenting is influenced by a complex mix of personal, social, and cultural factors, often leading to stress and exhaustion from competing demands. In Sweden, supportive policies like parental leave and childcare services encourage shared responsibilities and work–life balance. Despite these supports, many parents experience stress related to time constraints, mental health issues, and limited resources, which can impact both their parenting and their child's development.MethodA quantitative psychometric design was used. The Parental Stress Scale was translated into Swedish and tested among parents of children aged 0–5 years at two Child Health Centers. The data were examined through psychometric analysis, and a confirmatory factor analysis was performed to assess model fit.ResultsThe goodness of fit of the translated Parental Stress Scale was acceptable, indicating that the translation is appropriate for use in a Swedish context. The chi-square test revealed a significant p value, likely due to the small sample size, and the relative chi-square (1.48) fell within the recommended range (2.0–5.0).ConclusionThese findings suggest that the translated Parental Stress Scale should be used with caution, as it more accurately measures parental stress than satisfaction among this group of parents. Its use at Child Health Centers enables early stress detection among parents, supports interventions, and complements screening. In research, the scale can help evaluate parenting programs and long-term studies, promoting international comparison.

Introduction: The Swedish child health care (CHC) program provides voluntarily, at no cost, services for children from birth to 5 years old. Participation rates are 99% of Swedish parents enrolling their children in some form of CHC program. Parental groups, comprising parents with similar experiences, can help reduce parental stress and foster the development of effective coping strategies. The study is aimed at evaluating a digital support intervention involving parents, child health nurses, and researchers.Methods: This cluster-randomized, prospective pilot intervention study, conducted in northern Sweden, had three follow-up points: baseline, 4 months, and 8 months. Data were collected from autumn 2022 to late spring 2023 and evaluated effects on parental stress and satisfaction, eHealth literacy, and satisfaction with CHC, accessibility, and support. The 18-item Parental Stress Scale was used to assess parental stress and satisfaction. eHealth literacy was measured using the 10-item eHEALS scale, and parental satisfaction and opinions on accessibility to CHC were measured using a three-item Visual Analogue Scale. The intervention group was offered to participate in various digital activities, while the control group received the usual CHC.Results: Parental satisfaction and stress levels within and between the intervention and control groups showed no significant changes from baseline to 8 months. Regarding eHealth literacy, differences were observed between the groups; however, both groups demonstrated improvement at the 8-month follow-up. The control group scored higher in eHealth literacy from baseline. The same pattern was identified regarding the parents' perceptions of internet usability and importance. Concerning satisfaction with CHC, accessibility, and support, the control group scored higher at baseline. Interestingly, the lines of the intervention and control groups crossed over at the 8-month follow-up.Conclusion: Despite a limited outcome change, the results showed a tendency to benefit some parents. Our findings suggest that further evaluation, possibly with other more suitable measurements or questionnaires, an extended intervention period, and a larger sample, is necessary to understand the implications of these results fully.

Introduction: Sweden has an extensive national child health care programme (CHCP) implying that all parents are offered support to raise their children and support them for healthy development. The programme is today built on personal physical contacts and digital components unusual. Although the digital world could be frightening and insecure, it also has benefits, because it is not dependent on face-to face meetings and is accessible more hours. In order to develop a digital channel to complement the CHPC, for the support of parents of children within child health care (CHC), parents' perspectives must be investigated. The aim of the study was therefore to describe parents' needs and expectations of digital support in the context of child health care.

Methods: The study had a qualitative approach using workshop discussions with parents as data. The interview data were analysed using qualitative content analysis.

Results: The main theme highlights that parents expected that a digital support channel would be something that might strengthen them towards independence concerning the care of their children, in a positive way. However, they also felt that they needed personal support and that relationships with other parents and the child health care nurse were significant and meaningful. Another parental desire that emerged was that a future digital channel would facilitate and simplify access to care and they suggested having both planned and urgent times available for parents to book. The digital channel was expected to make this possible and be a good complement to the physical contacts the traditional child health care currently offers.

Discussion/Conclusions: The parents in this study believed that digital solutions could increase their parental power in relation to the care of their children. Examples were given as digital nurse-led parent groups where parents with similar problems and experiences around their children could support each other and were expected to strengthen them over time. The parents stressed that a planned digital support channel also needs satisfactory solutions for both contact and response and have bookable digital meetings for both planned and urgent needs.

Bakgrund: Den svenska barnhälsovården är frivillig och kostnadsfri, och de flesta svenska familjer följer programmet. Den är dock inte jämlikt fördelad över landet och kan därför behöva utvecklas med fler digitala element och bli mer familjefokuserad. Många, särskilt kvinnor, beskrivs behöva mycket stöd under övergången till föräldraskap och uppskattar professionell hjälp för att hantera känslomässig och psykosocial stress. Familjefokuserad omvårdnad ligger till grund för omvårdnadspraktiker inom barnhälsovården, vilket innebär att specialistsjuksköterskan skapar vård tillsammans med familjen och tar vara på alla kompetenser på bästa sätt. Att involvera föräldrarna i utvecklingen av barnhälsovården är därmed av yttersta vikt.

Syfte: Det övergripande syftet var att utröna hur föräldrar och Barnavårdscentralensspecialistsjuksköterskor (BVC-sjuksköterskor) uppfattar och använder Internet som en källa för hälsokompetens, samt att utvärdera effekten av en digital pilotinterventionutvecklad i samarbete med föräldrar med målet att minska föräldrastress, öka hälsolitteracitet och tillfredsställelse med barnavårdscentralen (BVC).

Metoder: Kvalitativa (I, III), mixade (II) och kvantitativa (IV) metoder baserade på intervjudata, gruppdiskussioner och frågeformulär användes i de fyra studierna som syftade till att; I) beskriva BVC-sjuksköterskors erfarenheter och åsikter om föräldrars internetanvändning, II) beskriva hälso- och barnutvecklingsrelaterade sökmönster på internet hos föräldrar till friska barn och hur informationen användes i kontakter med barnhälsovården (BHV), III) beskriva föräldrars behov och förväntningar på digitalt stöd i samband med barnhälsovård, och slutligen IV) utvärdera effekten av en digital pilotintervention riktad till föräldrar, avseende föräldrars stress och eHälsolitteracitet. Kvalitativa data analyserades med hjälp av kvalitativ innehållsanalys och kvantitativa data med beskrivande och jämförande statistiska metoder.

Resultat: Studie I visade att föräldrars internetanvändning påverkade BVC-sjuksköterskors arbete på olika sätt. Internet ansågs underlätta vård, tillgång och tillhandahållande men kunde också komplicera den professionella rollen och prestationen, vilket innebar att de upplevde ett imperativ för en förändrad roll som BVC-sjuksköterskor. I studie II framkom att föräldrar i mycket hög grad sökte på Internet efter hälsorelaterade ämnen, och resultaten belyser också frågan om svårigheterna att bedöma källornas pålitlighet. Studien visade också att Internet kunde stärka föräldrarna med ny kunskap och stödja deras förmåga till egenvård, men att denna kunskap å andra sidan också oroade dem och gjorde dem osäkra i sin föräldraroll. Studie III, som rapporterade om föräldrars behov av och förväntningar på digitalt stöd, visade att de ville bli mer självständiga i sitt föräldraskap men fortfarande behövde stöd och meningsfulla relationer. Viktiga aspekter, förutom förbättrad tillgänglighet som efterfrågades var ökad tillit långsiktiga relationer och stärkt oberoende. Studie IV visade att den digitalasupport-intervention inte gav de effekter på föräldrastress och e-hälsolitteracitet som förväntades, även om tendenser kunde identifieras. Detta ansågs främst bero på en alltför kort genomförandeperiod med alltför få deltagare, då det visades att endast en femtedel av familjerna i interventionsgruppen använde supporten, resten tycktes intebehöva den eller hade kanske ännu inte upptäckt nyttan av den.

Slutsats: Den digitala eran utmanar både föräldrar och BVC-sjuksköterskor. Digitalt stöd som utvecklas tillsammans, dvs där BVC-sjuksköterskor och föräldrar i samarbete kommer överens om hur, när och om vilka ämnen denna typ av stöd och kommunikation ska omfatta, kan dock upplevas som meningsfullt. Ett genomförande i större omfattningskulle öka tillgängligheten, samtidigt stärka föräldrarnas egenmakt och leda till mer långsiktiga relationer med andra föräldrar. Implementerat klokt bland fler deltagare och över längre perioder är det möjligt att den digitala supporten också kan ha mer positiva effekter på tillfredsställelse med BHV samt på minskad föräldrastress och ökad eHälsolitteracitet.

Background: Swedish child health care is voluntary and cost-free, and 99% of Swedish families follow the program. However, it is not equally distributed across the country and therefore needs to be developed to include more digital elements and become more family focused. Many, particularly women, need much support during the transition to parenthood and appreciate professional help to manage emotional and psychosocial stress. Family-focused care is the assumption underlying nursing practice within child health care, which means to co-create care with the family, making the most of all competencies. Involving parents in child health care development is therefore of utmost importance.

Aim: The general aim was to examine how parents and child health nurses apprehend and use the Internet as a source for improved health competence, further, to evaluate the effects of a digital pilot intervention developed together with parents to reduce parental stress, improve eHealth literacy and satisfaction with child health care.

Methods: Qualitative (I, III), mixed (II), and quantitative (IV) methods based on interview data, group discussions and questionnaires were used in the four studies that aimed to; I) describe child health nurses’ experiences and opinions of parent Internet use, II) describe health and child development related Internet search patterns of parents of healthy children and, how the information was used in contacts with child health care, III) describe parents’ needs and expectations of digital support in the context of child health care, and lastly IV) evaluate the effects of a digital pilot intervention directed to parents, concerning parental stress and eHealth literacy. Qualitative data were analyzedusing qualitative content analysis and quantitative data with descriptive and comparative statistical methods.

Results: Study I showed that parents’ Internet use influenced child health nurses’ work in various ways. Internet was seen as facilitating care, access, and provision but also complicated their professional role and performance, which implied that they experienced an imperative for a changing role as child health nurses. In study II, it was shown that parents, to a very high degree, searched the Internet for health-related topics, and the results also highlighted the problem of determining the trustworthiness of sources. The study also indicated that the Internet could strengthen parents with new knowledge and support their self-care capacity. However, on the other hand, this knowledge also worried them, making them insecure in their parental role. Study III, reporting on parents' needs and expectations of digital support, showed that they wished to become empowered in parenthood but still needed support and meaningful relationships. Important aspects, besides improved accessibility that were requested were improved parental confidence, longer-term relationships and strengthened independence. Study IV, which evaluated the effects of a pilot intervention,demonstrated limited effects on parental stress and e-Health literacy, even if tendencies were identified. This was mainly seen as related to a short intervention periodwith too few participants since only a fifth of the families in the intervention group used the intervention. The others did not need it or maybe had not discovered its benefits yet.

Conclusion: The digital era challenges both parents and child health nurses. However, digital support developed together, where child health nurses and parents in collaboration agree on how, when and regarding which topics this kind of support and communication should embrace could be experienced as meaningful. It would probably increase accessibility and parental empowerment and lead to longer-term relationships with other parents. Implemented wisely in larger samples and over more extended periods will probably also in a higher degree improve satisfaction with child health care, eHealth literacy and parental stress.

Att bli förälder är en livsomvälvande händelse som kan vara både glädjande och skrämmande. Som förälder ansvarar man för en annan människa där man i vissa fall behöver ny information, kunskap och råd för att leva upp till de nya kraven som en förändrad familjesituation kräver. Förmågan att tillgodogöra sig information, kunskap och råd kan relateras till begreppet hälsolitteracitet som berör hur personer förstår och tillgodogör sig hälsorelaterad information. Den svenska barnhälsovårdens mål är att främja barns hälsa och utveckling och förebygga ohälsa hos barn, samt stödja föräldrar i föräldrarollen. Barnhälsovårdens sjuksköterskor följer barnets hälsa och utveckling till dess att barnet fyller fem år och är en viktig del i stöttningen av föräldrarna. De flesta av dagens föräldrar är födda i den digitala generationen och Internet är en naturlig källa till information och ökad kunskap. Föräldrarnas hälsolitteracitet kan inverka på hur internetinformationen påverkar dem och deras agerande för att möta barnens behov. I nuläget är litet känt om hur informationsöverflödet från digitala källor som Internet används av föräldrar och i interaktionen med barnhälsovården. Denna licentiatavhandlings syfte är att generera ökad kunskap om hur föräldrar använder Internet för hälsorelaterad information relaterat till deras 0–6 åriga friska barn och hur detta kan påverka dem själva samt om och i så fall, hur detta inverkar på barnavårdssjuksköterskans konsultativa arbete. I licentiatavhandlingen ingår två delstudier: Delstudie I genomfördes som en kvalitativ intervjustudie med sjuksköterskor (n=20) verksamma inom Barnhälsovården. Syftet var att beskriva deras erfarenheter och uppfattningar om föräldrars internetanvändning. I resultatet framkom tre kategorier som belyste syftet: Det framkom att ”Internet underlättar vård samt tillgång och tillgänglighet av vård och vårdinformation”, vidare att ” Internet gör yrkesutövande mer komplext” samt till sist uttrycktes det ”Ett behov av förändrad yrkesroll för barnhälsovårdssjuksköterskan”. I delstudie II genomfördes en enkätundersökning med föräldrar (n=687) som hade barn inskrivna på barnhälsovården inom en region i norra Sverige. Syftet var att beskriva föräldrars internetanvändning för råd eller information relaterat till hälsa och barns utveckling för deras friska barn samt hur informationen användes i kontakten med Barnhälsovården. Nästan alla föräldrar (n=686), uppfattade att Internet är en bra informationskälla för råd och information om barns hälsa och utveckling, men de uttryckte osäkerhet inför mängden av information samt kring den egna förmågan att söka, sortera och värdera funnen information. I resultatet sågs också att många föräldrar 81,7% (n = 561) önskade ha stöd och vägledning av sin barnhälsovårdssjuksköterska avseende internetinformation och webbsidor. Licentiatavhandlingens resultat visar att föräldrar har ett behov av stöd och att barnhälsovårdens sjuksköterskor genom den uppbyggda relationen dem emellan både kan vägleda och ge råd för att stödja föräldrar. Genom att stödja föräldrar på detta sätt kan barnhälsovården bidra till att öka föräldrars hälsolitteracitet och därmed även deras hälsokompetens. Barnhälsovårdens medarbetare behöver kompetensutveckling och verktyg för att kunna stödja föräldrar mot större hälsolitteracitet och därigenom även en högre hälsokompetens. Det ses som viktigt att utveckla fler kvalitetssäkrade digitala verktyg som komplement till dagens Barnhälsovård baserad på personliga möten. Verktygen skulle kunna bestå i att stötta föräldrar till att söka och värdera information från evidensbaserade källor, samt att införliva chatt och videokonferensmöjligheter mellan föräldrar och barnhälsovårdssjuksköterskorna också inom offentlig sjukvård.

Becoming a parent is a life-changing event that can be both gratifying and scary. As a parent, one is responsible for another person, where there sometimes is a need for new information, knowledge, and advice to live up to the new requirements that a changing family situation requires. The ability to make use of information, knowledge, and advice can be related to the concept of health literacy that affects how people understand and make use of health-related information. The goal of Swedish child health care is to promote children's health and development and prevent ill-health in children, as well as support parents in the role of parenting. Child health care nurses follow the child's health and development until the child turns five years and is an important part of supporting the parents. Most of today's parents are born in the digital generation and the Internet is a natural source of information for increased knowledge. Parental health literacy can affect how Internet information affects them and their actions based on the needs of the children. At present, little is known about how the information flow from digital sources such as the Internet is used by parents and in the interaction with child health care. The purpose of this licentiate thesis is to generate increased knowledge about how parents use the Internet for health-related information related to their 0–6-yearold healthy children and how this may affect themselves and if so how this, in turn, affects the nurse's consultative work. The licentiate thesis includes two sub-studies: Sub-study I was conducted as a qualitative interview study with nurses (n = 20) active in child health care. The purpose was to describe their experiences and perceptions of parents' internet use. In the results, three categories emerged that highlighted the purpose: “The Internet facilitates care and access to care- and care information”, further “The Internet makes professional practice more complex” and finally “A need for a changing professional role for the child health care nurse". In sub-study II, a survey was conducted with parents (n = 687) who had children enrolled in child health care. The purpose was to describe parents' Internet use for advice and information related to health and child development for their healthy children and how the information was used in contact with child health care. Almost all parents (n = 686) perceived that the Internet was a good source of information for advice and information on children's health and development, but they expressed uncertainty about the amount of information and their own ability to search, sort and evaluate the information found. The results also showed that many parents 81.7% (n = 561) wanted support and guidance from their child health care nurse regarding internet information and web pages. The thesis results showed that parents need support and that the child health care nurses can both guide and advice to support parents through the established relationship between them. By supporting parents in this way, the child health care can promote parental health literacy. Based on the research carried out and to meet parental demand for advice on their children's health there is a proposal for a digital solution, a chat or a kind of digital reception where parents can consult the child health care nurse and confirm whether they thought right, or get additional advice and information, which would be an innovative proposal. The staff of Swedish child health care are in need of competence development, as well as tools in order to be able to support and promote parents towards health literacy. It seems necessary to develop adequate and quality assured digital tools as a complement to the present child health care which has its base in personal meetings. The tools could include the competence of supporting parents to search and validate information from evidence-based sources, as well as the incorporation of chat and videoconference possibilities between parents and child health nurses.

ABSTRACT Background: On the basis of parents? growing use of the Internet as a resource for health-related information, and the total lack of scientific literature about how nurses in child healthcare experience how their work is affected, further information is needed.Purpose: This study describes child health nurses? (CHN) experiences and opinions of parent Internet use.Design and methods: Using a qualitative descriptive approach, CHNs (n?=?20) working at Health Centres in northern Sweden were interviewed.Results: An overarching theme named ?Parents? use of Internet has influenced Nurses? work? was identified. The theme comprises three categories; ?Internet facilitating care, access, and provision?; ?The Internet complicating the professional role and performance?; and ?Sensing an imperative for a new role as a CHN.Conclusions: These findings add a fresh perspective to understanding the new and transformed professional role of CHNs.

Today’s parents belong to the digital generation and regularly use the Internet as a source of information. Parents’ quests for health-related online information comprise an effort to manage symptoms of illness or address questions about child development which may be an expression of self-management or self-care. Purpose: This study aims to describe health and child development related Internet search patterns used by parents of children ages zero to six, and further, how the obtained information was used in contacts with Child Health Care. Design and Methods: A two-step mixed- method approach is used in this study, comprising both a quantitative and a qualitative approach. First, a questionnaire was distributed to parents (n = 800) at 13 health centers in a medium sized county in Sweden. Second, one narrative interview with two parents total was conducted. Descriptive and non-parametric statistics were calculated, and qualitative manifest content analyses were performed. Results: A total of 687 completed the questionnaire, which corresponds to a response rate of 86%. The results show that 97% used the Internet for health-related and developmental child issues. The results show that parents often look at basic tips and the Internet is seen as a fast and accessible forum to obtain information. Parents often initiated their Internet searches using Google search for the specific subject, but the most common and most used website (used by 95% of parents), was the Swedish health site 1177.se. 98.4% of parents evaluated the general information searches they made on the Internet as reliable despite only 31% of the parents checking to see if the websites they used were scientifically based. Parents (81.7%) stated that they wanted their Child Health Nurses (CHN) to give them recommendations for valid websites. Conclusions: The results in this study show that, on the one hand, the Internet could strengthen parental knowledge (support self-care capacity), but, on the other hand, the found information could worry them and increase their anxiety—negatively affected self-care capacity. The parents suggested that the information should be double-checked to establish trust and develop self-care knowledge. Having a good resource to rely on, such as personal contact with a CHN, or using reliable websites seems to strengthen and reassure parents.