Burdened parents sharing their concerns for their children with the doctor.  <i>The impact of trust in general practice: a qualitative study</i>

Hafting, Marit; Gullbrå, Frøydis; Anderssen, Norman; Rørtveit, Guri; Smith-Sivertsen, Tone; Malterud, Kirsti

doi:10.1080/02813432.2019.1639907

Cited by 3 publications

(3 citation statements)

References 30 publications

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“…It has previously been found that an interested conversation style (as opposed to a reserved conversation style) facilitates the discussion of psychosocial aspects during developmental assessments [ 25 ]. Trust is an important component of the clinician-patient relationship and is needed in order to address sensitive topics [ 44 , 45 ]. Some clinicians felt awkward asking sensitive questions, perhaps because they lacked communication skills or because the child records do not adjust to the fact that a relationship needs to be established before addressing such topics.…”

Section: Discussionmentioning

confidence: 99%

Increasing the psychosocial focus in child developmental assessments: a qualitative study

et al. 2023

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Background Previous studies have indicated a need for increased psychosocial focus on children and their families to improve children’s wellbeing and mental health. Child developmental assessments could be a place to implement changes to achieve this. A standardised record might be helpful to clinicians trying to increase psychosocial focus. The aim of this study is to investigate clinical barriers and facilitators when introducing standardised child records with increased focus on psychosocial wellbeing and mental health into child developmental assessments. Methods This is a qualitative study based on 12 semi-structured interviews with four midwives and nine doctors who carry out child developmental assessments in general practice. Data is analysed in the framework of Normalisation Process Theory. Results General practice-based clinicians were positive towards increasing the psychosocial focus in child developmental assessments. The main barriers when clinicians used the standardised child records were: feeling forced to ask certain questions, in turn making the conversation rigid; leaving less room for parents to bring up other issues; making clinicians feel awkward when addressing problems that they cannot solve; the need for extended consultation time; and medico-legal concerns when registering findings. The experience of positive aspects when using the standardised child records facilitated continuous use of the records. Positive aspects included having a standardised approach to recording important findings, thereby uncovering psychosocial problems that could potentially be overlooked. Additionally, structured observation of parent–child interaction and gaining a new vocabulary to describe the findings were valued by clinicians. Balancing a standardised approach with clinicians’ ability to steer the consultation and explore topics in depth while preserving the potential for patients to bring up other issues became an important theme. Conclusion Clinicians need to be well-equipped to handle psychosocial problems through coping strategies, referral options and communication techniques in the psychosocial domain. The parent–child-interaction assessment might expose potentially dysfunctional parenting behaviours and could improve communication between health professionals. Implementing standardised child development records with an increased psychosocial focus is feasible but improvements could optimise the use of the records. Parental views on an increased psychosocial focus during child developmental assessments should be investigated prior to further implementation. Trial registration Trial registry number for the FamilieTrivsel (Family Wellbeing) trial: NCT04129359.

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Section: Discussionmentioning

confidence: 99%

Increasing the psychosocial focus in child developmental assessments: a qualitative study

et al. 2023

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“…Shared decision-making plays an important role, thus talking about psychosocial aspects during developmental assessments has to be negotiated between parents and clinicians while respecting parental autonomy and preferences [55]. Clinicians having an open-minded attitude and interested communication style as well as parental trust in their clinician are other important factors that influence the acceptability of addressing psychosocial factors [29,30,[55][56][57][58]. Disclosing private information involves boundaries regarding whom the information is shared with and mechanisms to protect the information from outsiders [59].…”

Section: Discussionmentioning

confidence: 99%

Increased family psychosocial focus during children’s developmental assessments: a study of parents’ views

Strøyer de Voss,

Wilson,

Kirk Ertmann

et al. 2024

BMC Pediatr

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Background Family psychosocial challenges during the early years of a child’s life are associated with later mental and physical health problems for the child. An increased psychosocial focus on parents in routine child developmental assessments may therefore be justified. Methods Participants in this qualitative study included 11 mothers and one parental couple (mother and father) with children aged 9–23 months. Participants were recruited to Project Family Wellbeing through their general practice in Denmark. Twelve interviews were conducted, transcribed and analysed with a deductive approach. The topic guide drew on the core components of the Health Belief Model, which also served as a framework for the coding that was conducted using thematic analysis. Results Results are presented in four themes and 11 subthemes in total. Parents welcome discussion of their psychosocial circumstances during their child’s developmental assessments. Clinicians’ initiatives to address psychosocial challenges and alignment of parents’ and clinicians’ expectations may be required to allow this discussion. A flowing conversation, an open communication style and a trustful relationship facilitate psychosocial discussion. Barriers included short consultation time, concerns about how information was used and when parents found specific psychosocial aspects stigmatising or irrelevant to discuss. Conclusion Enquiry about the family’s psychosocial circumstances in routine developmental assessments is acceptable among parents. Alignment of clinical and parental expectations of developmental assessments could facilitate the process. Future research should examine the predictive validity of the various components of developmental assessments. Trial registration This is a qualitative study. The study participants are part of the cohort from Project Family Wellbeing (FamilieTrivsel). The project’s trial registry number: NCT04129359. Registered October 16th 2019.

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“…GPs’ perceived mandate of trust from the parents was a precondition for the children’s situation to be addressed. Some GPs took an open mandate from the parent for granted, while others assumed that the parent did not want to discuss their family situation [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Awareness of parental illness: a grounded theory of upholding family equilibrium in parents on long-term sick-leave in primary health care

Oja

Edbom

Nager

et al. 2021

Scandinavian Journal of Primary Health Care

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Objective: To understand the main concern of chronically ill parents and how they resolve this concern in relation to their children. Design: Grounded theory. Setting: Three primary health care clinics in Sweden. Subjects: Thirty-two interviewed parents and their children. Main outcome measures: Processes and typologies of upholding family relationships. Results: A concern of chronically ill parents is sustaining family equilibrium, achieved through a process of upholding family relationships. How a parent upholds depends upon his/her comprehension of the illness and of their child's need for parenting. In response to the parent's upholding behaviours, children mirror the effect of the illness to the parent, the child's specific behaviour depending on his/her level of comprehension regarding the parent's illness. Their combined behaviours create an awareness context that may be closed, concealed, suspicious, conflicted, mutual pretence or open. When the parent drives and facilitates the evolution of comprehension, the context quickly evolves from closed to open. When the parent hinders the process by masking and resisting the child responds by probing and proving and they become locked into a suspicious or conflicted awareness context with high relational tension. To create family equilibrium the parent needs to reveal and facilitate the awareness process. Conclusion: Parents on long-term sick leave in primary health care can need assistance to facilitate the awareness context of themselves and their child. Implications: Clinicians can identify the current awareness context of their patient and help their patient towards increased understanding of their illness; their child's needs and the parental capacities needed to reveal the illness and its impacts. KEY POINTSChildren are affected when parents are ill; they wish for information on their parent's illness. Effective interventions are available in settings other than primary health care and possibilities seen by GPs and families in Scandinavian primary health care have been previously described. There is a knowledge gap in how parents view themselves and their parenting when ill in primary health care. An analysis grounded in interviews was needed to generate a hypothesis (theory) of parental concerns and behaviours.This theory proposes that an important concern of chronically ill parents is to sustain family equilibrium, which they attempt to do by upholding family relationships. Specific upholding behaviours include masking, resisting, colluding, and revealing. In response, children will engage in mirroring behaviours. Which paired behaviours are enacted will depend upon the respective levels of comprehension of parent and child regarding the illness and on the child's need for parenting. In their interactions, parent and child create one of six awareness contexts.Identifying the current awareness context in the family about chronic parental illness provides clinicians with a conceptual tool to better support those families locked in suspicious or conflicted ...

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Burdened parents sharing their concerns for their children with the doctor. The impact of trust in general practice: a qualitative study

Cited by 3 publications

References 30 publications

Increasing the psychosocial focus in child developmental assessments: a qualitative study

Increasing the psychosocial focus in child developmental assessments: a qualitative study

Increased family psychosocial focus during children’s developmental assessments: a study of parents’ views

Awareness of parental illness: a grounded theory of upholding family equilibrium in parents on long-term sick-leave in primary health care

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