Children in primary child health care : studies on HOW children participate in health visits

The Swedish Primary Child Health Care (PCHC) is a service provided for children with the purpose of promoting children’s health and development in the 0-6 years-age group. The service is provided through health visits. The children participate in these visits as actors, from their own perspective through bodily and verbal expressions. Although, the children are the main consideration of the PCHC service, their perspectives and perceptions of this setting have not been explored.

The aim of this thesis was to explore and describe three-, four- and five-year-old children’s expressions of participation in various situations in PCHC visits (I, II, III), and to describe five-year-old children’s perceptions of undergoing an immunization (IV).

In Study I, II and III video observations and a hermeneutic approach were used to capture the children’s expressions in the various situations. To understand the children’s various perceptions of undergoing an immunization procedure, drawings and reflective talks were used from a phenomenographic approach (IV). The same children were invited to take part in the different studies due to ethical considerations. In Study I and II the expressions of 28 children were analysed, and in Study III the expressions of 22 children. In Study IV 23 children took part.

The findings show how the children in joint action with the nurse and their parents progressed through various states (I); from a state of getting ready, to a state of being ready and further to a state where they strengthened their own self. The children could also be in a state of not being ready and of being adverse. In these different states the children used various strategies as tuning in (III), affirmative negotiation (II, III) and delaying negotiation (II, III). In study IV, three various perceptions of undergoing the immunization were identified among the children: It wasn’t frightening, it didn’t hurt, it felt good, It was frightening, I believed it would hurt, I had to deal with it, and I wanted to get away, it felt no good.

Recognizing children’s perspectives and perceptions will help nurses to act with sensitivity when inviting children and guiding them through health visits. The thesis will also contribute to the development of a child-centred care and the promotion of children’s right to participate.

List of scientific papers

I. Harder, M., Christensson, K., & Söderbäck, M. (2009). Exploring three-yearold children in a primary child health care situation. Journal of Child Health Care. 13(4), 383-400.
https://doi.org/10.1177/1367493509344822

II. Harder, M., Christensson, K., & Söderbäck, M. (2011). Four-year-old children’s negotiation strategies to influence and deal with a primary child health care situation. [Accepted]
https://doi.org/10.1111/j.1099-0860.2011.00365.x

III. Harder, M., Christensson, K., Coyne, I., & Söderbäck, M. (2011). Five-yearold children’s tuning-in and negotiation strategies in an immunization situation. Qualitative Health Research. 21(6), 818-829.
https://doi.org/10.1177/1049732311400629

IV. Harder, M., Christensson, K., & Söderbäck, M. Five-year-old children’s perceptions of undergoing an immunization procedure. [Submitted]