Implementation and use of Web-based National Guidelines in Child Healthcare

Sammanfattning: In Sweden, child healthcare (CHC) is an important health promotion setting, providing universal and targeted interventions. High demands on child healthcare and the competences of CHC nurses, highlight the importance of access to supportive web-based guidelines in everyday work. The implementation of web-based guidelines is affected by various factors and can be challenging. The Swedish Rikshandbokenis national guidelines for CHC that are in the process of being implemented. The overall aim of this thesis was to investigate the CHC provided in Sweden before the implementation of the national CHC programme, and the implementation and usage of web-based national guidelines for CHC. Study Iaimed to investigate whether the Swedish CHC programme was equal and which methods for health surveillance the county councils offered. A web-survey distributed to CHC coordinators was used, and the data were analyzed with descriptive statistics. Study IIaimed to investigate how nurses in CHC use Rikshandboken and factors affecting its use. A web survey was used and analysed using descriptive and analytical statistics. Study IIIaimed to investigate CHC coordinators´ experiences of being a facilitator in the implementation of a new national CHC programme in the form of a web-based guide. Focus group interviews via Skype for Business were conducted and analyzed using qualitative content analysis. Study IVaimed to examine CHC nurses´ use and ways of understanding the national web-based guidelines, Rikshandboken. A mixed method with sequential explanatory design in two phases was used; a web-survey with descriptive statistics followed by telephone interviews with phenomenographic analysis. Study Vaimed to investigate the usage of the national web-based guidelines, Rikshandboken. The data were collected from Google Analytics, and analyzed using descriptive statistics. The results of the studies show that Rikshandbokenis widely used and that its usage has increased. CHC nurses are generally satisfied with the website and emphasizes the importance of national guidelines for CHC. Factors needed to be developed to improve Rikshandbokenwere suggested as well as prerequisites that are needed in the local context to use Rikshandbokenfully. It must be reliable, useful and relevant why the end users need to be involved in the development. With the right conditions, Rikshandbokencould be a resource for learning and a tool in everyday work for CHC nurses. The result also shows that the CHC is provided unequally, and that the CHC programme is challenging to implement in the local context. The CHC coordinators´ task is to facilitate the implementation of the web-based national guidelines; however, this responsibility is complex. Changing the content, structure and access to Rikshandbokenis not sufficient, in the local context, prerequisites for the use of these web-based national guidelines must exist, and only then can Rikshandbokenbe a contributing determinant to an equal CHC.