A better start for health equity? Qualitative content analysis of implementation of extended postnatal home visiting in a disadvantaged area in Sweden
Open accessAbstract
BACKGROUND: Health inequities among children in Sweden persist despite the country's well-developed welfare system and near universal access to the national child health care programme. A multisectoral extended home visiting intervention, based on the principles of proportionate universalism, has been carried out in a disadvantaged area since 2013. The present study investigates the content of the meetings between families and professionals during the home visits to gain a deeper understanding of how it relates to a health equity perspective on early childhood development. METHODS: Three child health care nurses documented 501 visits to the families of 98 children between 2013 and 2016. A qualitative data-driven conventional content analysis was performed on all data from the cycle of six visits per child, and a general content model was developed. Additional content analysis was carried out on the data from visits to families who experienced adverse situations or greater needs. RESULTS: The analysis revealed that the home visits covered three main categories of content related to the health, care and development of the child; the strengthening of roles and relations within the new family unit; and the influence and support located in the broader external context around the family. The model of categories and sub-categories proved stable over all six visits. Families with extra needs received continuous attention to their additional issues during the visits, as well as the standard content described in the content model. CONCLUSIONS: This study on home visiting implementation indicates that the participating families received programme content which covered all the domains of nurturing care as recommended by the WHO Commission on Social Determinants of Health and recent research. The content of the home visits can be understood to create enabling conditions for health equity effects. The intervention can be seen to represent a practical example of proportionate universalism.
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Home visits represent a cost-effective way of identifying and supporting vulnerable families.
“Home visits represent a cost-effective way of identifying and supporting vulnerable families (Olds et al., 2007; Barboza et al., 2018).”
From Extended home visits can provide multidimensional adapted professional support for parents – an intervention study (2023) · cites this paper as Barboza et al., 2018
The Results (‘Families with extra needs’; page not provided) describe visits in which professionals identified and addressed families’ specific needs, and the Discussion (‘Proportionate universalism in practice’; page not provided) describes needs assessment and additional support. The paper does not establish that home visits are cost-effective; its reported analysis is qualitative, not an economic evaluation. (LLM, conf=0.88)
Experimental — accuracy not yet measuredWhen child health care nurses, in collaboration with family supporters, offer parents more home visits during their children's first year of life, their parenting abilities are strengthened, which has positive effects on their children's health.
“International research has shown that when child health care (CHC) nurses, in collaboration with family supporters (within social service), offer parents more home visits during their children’s first year of life, their parenting abilities are strengthened, which has positive effects on their children’s health (Aronen and Arajarvi, 2000; Olds et al., 2007; Barboza et al., 2018).”
From Extended home visits can provide multidimensional adapted professional support for parents – an intervention study (2023) · cites this paper as Barboza et al., 2018
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Experimental — accuracy not yet measuredEven if they were proportionate most of them were not universal but specifically implemented in deprived area.
“Even if they were proportionate most of them were not universal but specifically implemented in deprived area (37,50,62).”
From Theoretical and practical challenges of proportionate universalism: a review (2020) · cites this paper as [62]
Home visits can especially support three-way relationships between mother and child, father and child, and mother and father, in addition to strengthening the role of each parent.
“Research has reported that home visits can promote healthy family functioning and positive parenting in early childhood (Minkovitz et al., 2016) and can especially support three-way relationships between mother and child, father and child, and mother and father, in addition to strengthening the role of each parent (Barboza et al., 2018).”
From Extended home visits can provide multidimensional adapted professional support for parents – an intervention study (2023) · cites this paper as Barboza et al., 2018
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References 27 · Cited by 43
Research works printed but not linked: 21
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- Authors
- Barboza, M., Kulane, A., Burström, B., & Marttila, A.
- Affiliations
- Karolinska Institutet (SE)
- Corresponding author
- Barboza, Madelene
- Venue
- International Journal for Equity in Health
- Published
- 2018-04-10
- Volume
- 17
- Issue
- 1
- Pages
- 42-42
- ISSN
- 1475-9276 (ISSN-L)
- PMC
- PMC5894165
- OpenAlex
- W2801208507
- Cited by
- 43
- References
- 27
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 3 · 2023: 7 · 2022: 9 · 2021: 7 · 2020: 5 · 2019: 2 · 2018: 1
- FWCI
- 5.73
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal for Equity in Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Stockholms Läns Landsting
- Public Health Agency of Sweden
- Topics
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Social Sciences › Health › Public Health and Social Inequalities
- Keywords
- health equity, early childhood development, child health care, proportionate universalism, nurturing care, pediatric nurses, disadvantaged families, social determinants of health, family support
- MeSH terms
- Child Health, Maternal-Child Health Services, Health Equity, Child, Child, Preschool, Female, Health Surveys, House Calls, Humans, Infant, Postnatal Care, Poverty, Sweden, Vulnerable Populations
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