Positive Health dialogue tool and value-based healthcare: a qualitative exploratory study during residents’ outpatient consultations

ObjectiveTo explore how residents experienced the application of the Positive Health dialogue tool (PH-tool) during outpatient consultations and its influence on the delivery of value-based healthcare (VBHC).DesignQualitative study using non-participant observations of outpatient consultations during which residents used the PH-tool, followed by longitudinal individual, semistructured interviews. To analyse the data from observations and interviews, observational form notes’ summarisation and categorisation, and an iterative-inductive thematic approach was used.ParticipantsEight residents—five from the ear, nose, and throat-department and three from the gastroenterology-hepatology-department—were selected through convenience sampling, accounting for 79 observations and 79 interviews.ResultsResidents had bivalent experiences with using the PH-tool. Residents discussed three main benefits: a gained insight into the individual patient’s context and functioning, a changed dynamics in resident–patient communication, and an increased awareness regarding value in terms of patient-related outcomes and healthcare costs. Three barriers became apparent: doubts regarding the PH-tool’s relevance and scope, boundaries of superspecialised medical professionals, and a lack of demarcation in clinical practice.ConclusionThe PH-tool use can be beneficial for residents during outpatient consultations with new patients and follow-up in cases of multidimensional problems, particularly in cases of chronic conditions and generalist care. In these situations, the tool yielded valuable patient information beyond physical health, helped foster patient engagement, and enabled tailoring the treatment plan to individual patients’ needs. On the other hand, the PH-tool was not a good fit for simple problems, clearly demarcated help requests, periodic follow-up consultations, or verbose patients. In addition, it was not suitable for superspecialised care, because it yielded an abundance of general information. For particular patients and problems, using the PH-tool seems a promising strategy to increase VBHC delivery. Nevertheless, further research and detailing is needed to better align the PH-tool’s broad intent and clinical practice.

School nurses’ experiences and challenges of working with childhood obesity in Northern Sweden: A qualitative descriptive study

Childhood obesity is increasing in Sweden. All children are offered regularly spread health visits to a school nurse. As health visits include a measure of height and weight and a health dialogue, school nurses can discover, disclose, and treat a child's weight gain. The aim of this study was to describe school nurses’ experiences and challenges in working with childhood obesity. This qualitative study collected data through focus-group discussion and semi-structured interviews with ten female school nurses from six municipalities. Data were analysed inductively using manifest qualitative content analysis. The study was reported using the COREQ guidelines. Stigmatization and lack of resources are major challenges for school nurses working with childhood obesity, and they experience frustration, powerlessness and feel that they provide unequal treatment. The present study concludes that obesity stigmatization is a widespread challenge for school nurses. They cannot alone generate all the resources needed or conquer all challenges. Evidence-based guidelines, increased knowledge, time for reflections and peer support could potentially empower school nurses, reduce frustration, and improve the quality of and equality in childhood obesity treatment.

Health Dialogue Experiences of Students, Teachers and School Nurses in Swedish Health-promoting Schools

According to Swedish law, all students are to be offered health dialogues with a school nurse, which helps to promote students’ health literacy. However, research shows that the health dialogues are not being used to their fullest potential. To explore how health dialogues are experienced by school actors – students, teachers and school nurses. The 93 participants from 14 municipalities in northern Sweden wrote open letters sharing their experiences with health dialogues. Phenomenological analysis resulted in two themes with three sub-themes each that describe well-functioning health-promoting schools in which health promotion was seen as a shared practice among staff. In contrast, the participants expressed frustration or resignation with the challenges connected to health dialogues. When given a voice, school actors paint an informative collective picture of health dialogues. Based on our findings, we argue that health dialogues can \promote students' health literacy and enable collaboration between different actors within educational systems. Furthermore, promoting health in school must be viewed as a common assignment for all school staff, and support from school leadership is needed to systematically use the results from health dialogues to inform effective health promotion practice.

Setting sail and returning home. Research voyaging in Aotearoa

We are drawn to this Talanoa in response to the call from Pacific Health Dialogue for frank and open discussion. Our contribution to the conversation is some reflections about our experience of academic health research as a collective of Māori and Pacific researchers trying to navigate within a large national research programme. Alongside this we will share the voyaging framework we developed to help locate ourselves as a collective, and articulate our needs and aspirations as early to mid-career researchers. Our collective met in the context of working with A Better Start – E tipu e rea, a National Science Challenge created by the New Zealand government.1 Better Start focuses on the health of children and young people across five key areas; healthy weight, resilient teens, successful literacy and learning, big data and Vision Mātauranga. Our team came together as collaborators within the Big Data theme, to explore the Integrated Data Infrastructure (IDI) as an area of possibility and challenge for both Māori and Pacific communities.

Elucidating the child’s perspective in health promotion: children’s experiences of child-centred health dialogue in Sweden

Summary Promoting young children’s health through health promotion activities is an investment for the future. In the Child Health Services in the south of Sweden a structured Child-Centred Health Dialogue (CCHD) directed to all 4-year-old children was developed using illustrations based on the most important health messages associated with the promotion of healthy lifestyle in preschool children. The aim of this study was to explore the experiences of children participating in CCHD using 21 non-participant observations during their 4-year health visit and additionally 16 individual interviews 0–7 days after their visit, conducted in the child’s home in the presence of a caregiver. Children participated as social actors when guided to express their views based upon their own understanding was the overall main category generated from the qualitative content analysis. The children showed that they liked to participate actively but could influence their choice to participate. They expressed their views based on their daily life and wanted to understand the meaning of the information with which they interacted. The study revealed that 4-year-old children given the opportunity to speak for themselves—elucidating the child’s perspective—interpreted the health messages in a different way than the intended meaning of the illustrations developed by adults. These findings are important for the improvement of CCHD and underline the utmost importance of including children in research on health promotion. This study supports the view that 4-year-old children can take an active role in their health and are capable of making health information meaningful.

Health Dialogue Elements Identified during Health Communication between Nurses and Patients

Nurse-patient communication is an essential component of patient-centred health care that improves health outcomes and is characterised by health dialogue sanctioning mutual participation of both parties. This article reports on a study that aimed to identify the use of health dialogue elements during nurse-patient communication. A quantitative, descriptive, cross-sectional research design was used. The data was collected using the Observational Checklist of Health Dialogue Elements (OCHDE). The population comprised nurses (N=89) and adult diabetic patients in their care in a local municipality in Northern Cape, South Africa. Proportional sampling of public and private health facilities (n=16) was followed by convenience sampling of nurses (n=22). Descriptive statistics were calculated per group, comparing the nurse and patient responses per health dialogue element. The use of health dialogue elements during nurse-patient communication was diverse with an inconsistent display of antecedents, namely, a positive attitude (71.4%) and sensitivity and respect (41.7%) during communication. Regarding the antecedent element, training, the nurses displayed inadequate training in diabetes (19.3%) and in communication skills (30.6%). The patients received more diabetes training (48.7%) than the nurses, but their communication skills training (3.4%) was low. However, both the nurses and patients perceived the empirical referents, namely, shared responsibility/decision-making (67%, 68.2%), a health plan of mutual benefit (79.5%, 81.6%), and the use of context-sensitive communication strategies (73.6%, 67.8%). The inconsistent presence of antecedents and the reported presence of empirical referents indicates a need for further research and capacity building of nurses and patients.