A qualitative exploration of factors that facilitate and impede adherence to child abuse prevention guidelines in Dutch preventive child health care

Rationale, aims and objectives In the Netherlands, evidence-based child abuse prevention (CAP) guidelines have been developed to support child health care professionals (CHPs) in recognizing and responding to suspected child abuse. The aim of this study was to identify factors related to characteristics of the guidelines, the user, the organization and the socio-political context that facilitate or impede adherence to the CAP guidelines. Methods Three semi-structured focus groups including 14 CHPs working in one large Dutch child health care organization were conducted in January and February 2012. Participants were asked questions about the dissemination of the guidelines, adherence to their key recommendations and factors that impeded or facilitated desired working practices. The interviews were audiotaped and transcribed. Impeding and facilitating factors were identified and classified. An innovation framework was used to guide the research. Results CHPs mentioned 24 factors that facilitated or impeded adherence to the CAP guidelines. Most of these factors were related to characteristics of the user. Familiarity with the content of the guidelines, a supportive working environment and good inter-agency cooperation were identified as facilitating factors. Impeding factors included lack of willingness of caregivers to cooperate, low self-efficacy and poor inter-agency cooperation. Conclusions The results indicate that a broad variety of factors may influence CHPs' (non-)adherence to the CAP guidelines. Efforts to improve implementation of the guidelines should focus on improving familiarity with their contents, enhancing self-efficacy, promoting intra-agency cooperation, supporting professionals in dealing with uncooperative parents and improving inter-agency cooperation. Recommendations for future research are provide

Effects of a computerised guideline support tool on child healthcare professionals’ response to suspicions of child abuse and neglect: a community-based intervention trial

Background Healthcare professionals’ adherence to guidelines on child protection is not self-evident. This study assessed the effects of a computerised support tool on child healthcare professionals’ adherence to the seven recommended guideline activities, and on time spent seeking information presented in this guideline. Methods A community-based intervention trial design was applied, comparing access to a paper-based guideline (control) with access to a paper-based guideline supplemented with a computerised guideline support tool (intervention). A total of 168 child healthcare doctors and nurses working in one large Dutch organisation were allocated to an intervention or control group. Outcomes were professionals’ performance of seven recommended guideline activities and the amount of time spent seeking information presented in the guideline. Professionals’ adherence was measured using two methods: health record analysis and a self-report questionnaire. The questionnaire was also used to collect data on the amount of time spent seeking guideline information. Results In total, 152 health records (102 in the intervention group and 50 in the control group) were available for analysis. The tool was registered in 14% of the records in the intervention group. Performance of activities, corrected for intentional non-adherence, was except for one activity, high (range 80–100%); no differences were found between the control and intervention groups. Forty-nine questionnaires (24 in the intervention group and 25 in the control group) were analysed. Sixty-three percent of the questionnaire respondents (15/24) claimed to have used the tool. No differences in guideline adherence were found between the two groups. Respondents in the intervention and control groups spent, on average, 115 and 153 min respectively seeking relevant information presented in the guideline. Conclusions The results regarding use of the tool were inconclusive as the outcomes differed per method. In contrast to expectations, performance of guideline activities was high in both groups. The support tool may decrease the amount of time spent on seeking guideline information. However, given the high adherence scores and small number of questionnaire respondents, the outcomes failed to reach statistical significance. Future research should focus on studying the effects of the tool after a longer period of availability

Voorkeurshouding bij zuigelingen: prevalentie, preventie en anpak.

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