Group-based Parental Support in Child Health Service. Development and evaluation of a group leadership course for nurses.

The close relationship between young children’s living conditions and their health
later in life is well documented and a safe and healthy environment during early
childhood promotes cognitive functions and social development during the whole
lifespan. Becoming a parent is a major life transition and it is sometimes described as a stressful and vulnerable time involving changes to lifestyle and routines. Parental groups are an important part of Swedish parental support and are offered to almost all parents in Sweden by the Child Health Service (CHS) during their child’s first year, but only half of the parents choose to participate.

The overall aim of this thesis was twofold, first to elucidate group-based early parental support provided by the CHS from the perspective of CHS nurses and parents, and secondly, based on the findings, to develop and evaluate a group-based intervention including a course in group leadership. Study A was a cross sectional study involving CHS nurses and parents with experiences from parental groups within CHS from one county in Sweden. A total of 156 CHS nurses from 31 of 33 municipalities and 143 parents from 71 parental groups at 27 different Child Health Care centres (CHC) completed two different questionnaires about their experiences of the parental groups provided by the CHS. Based on the findings of Study A, an intervention consisting of a course in group leadership was developed and evaluated in Study B. Fifty-six CHS nurses participated in a three-day course in group leadership. The intervention was evaluated using pre- and post-test questionnaires, a course evaluation, an open interview with course leaders and focus group interviews five to eight months after the course.

The findings in Study A showed that almost all CHS nurses managed parental groups and that specialized parental groups (groups for e.g., single parents or parents with non-Swedish backgrounds) were managed by half of the nurses and were more common at family centres. The participating parents were mostly Swedish, married, well-educated, working mothers who found the parental groups to be meaningful and strengthening. More than half of the parents had met someone with whom they socialized outside of the parental group meetings. Most of the topics addressed in the parental groups were of interest for both the CHS nurses and the parents, but the parents wanted more focus on topics such as parenting, child related community information and sex and relationships. Most of the parents were content with the group management, the nurses however felt that group leadership was difficult and challenging and expressed a need for education in group dynamics and group leadership. The CHS nurses who participated in the group leadership course in Study B felt strengthened in their group leader role and expressed a change in perception towards the work task. The group leader role was clarified and the nurses received the knowledge they needed to further develop their group leadership skills. They described that they had started to work differently with the groups and use their new tools to plan and perform the parental groups in new ways. The nurses felt encouraged to work with their parental groups and expressed feeling increased job satisfaction.

Despite extensive experience of leading parental groups, CHS nurses feel insecure in group leadership. A course in group leadership seems to strengthen the CHS nurses in their group leader role and might help them fulfil the objectives of parental groups. Parents attending CHCs with high Care Need Index are underrepresented in parental groups and there is a need to adjust the support to reach more parents. The parental groups have been performed more or less the same way since implemented in 1978 and other needs and demands may have risen. Improved confidence in group management might motivate the CHS nurses to further develop parental groups to attract the parents who currently choose not to participate.