Cultural competence in primary child health care services : interaction between primary child health care nurses parents of foreign origin and their children

Sammanfattning: Background and aim: Every third child assigned to the Primary Child Health Care services in Stockholm County is of foreign origin. The aim of this thesis was to explore aspects that might risk an optimal and high quality interaction between the nurses and parents of foreign origin and their children in the clinical child health services. An additional aim was to use this knowledge to create a specific training in cultural competence directed to nurses and evaluate the effectiveness of this. Material and methods: Both quantitative (Study I and IV) and qualitative (Study II and III) research methods were selected. Study I: quantitative data collection among nurses (n=270) through a questionnaire and data analysis using logistic regression. Study II: qualitative data collection among nurses (n=19) through interviews utilising Grounded Theory Methodology (GTM). Study III: qualitative data collection among parents (n=21) through interviews utilising GTM. Study IV: quantitative data collection through questionnaires in pre- and poststudy design among the intervention group (n=24) and a control group (n=27) of nurses. Data analysed using the Wilcoxon signed-rank and Wilcoxon rank-sum tests and variance analysis. Results: The nurses reported insufficient working conditions and cultural competence. They experienced difficulties in their interaction with this group of children and their parents, and the difficulties were particularly associated with long professional experience, full-time work and a high proportion of children of foreign origin. The nurses main concern turned out to be their anxiety about missing children being exposed to risks of ill-health due to various conditions in their home environments. Unfamiliar and not understandable psychosocial conditions created difficulties for the nurses when trying to assess health risks for the child s health and development. A theoretical model was created that explains the process of assessing risks for the child s health and various elucidating strategies used by the nurses. The parents main concern turned out to be their feelings of exposure and anxiety about being misjudged as parents due to their origin. Hence they were watchfully checking rapport i.e. if they could perceive sympathy and understanding from the nurses. A theoretical model was created that illustrates the interactive process between parents and nurses and factors determining whether parents believed that rapport was possible to be established. After specific training, the intervention group of nurses rated their cultural competence to be somewhat improved, especially their cultural skills. Conclusions: Deficient working conditions, lack of cultural competence and experiences of difficulties were found among nurses. Assessing risk factors in a child s home environment seems to be a difficult task for nurses in need of certain competence, skills and elucidating strategies. These strategies could further be developed and frame the nurses cultural skills when performing their assessment of health risks for the child. The possibility to establish rapport with the nurse can prevent parents from feeling hesistant and unwilling to bring the child in for check-ups. Thus, it is crucial for nurses to become aware of their own demeanour and way of interacting with parents and children of foreign origin. The concept of establishing rapport frames and elaborates the concerns of cultural encounters and cultural competence in the context of child health services. Short, specific training programmes in cultural competence are helpful for nurses, who rate them as having an impact on their ability to cope with the demands of working with parents and children of foreign origin. Findings and theoretical models in this thesis are important tools for professional reflection, as a means for teaching cultural competence and as a basis for further exploration and conceptualisation.