Implementation of the norwegian ‘Starting right’ child health service innovation: implementation adjustments, adoption, and acceptability

Abstract

Background: An increased and/or stable proportion of the child and adolescent population reports symptoms ofimpaired health, and the symptoms can be identified early. Therefore, structured child- and parent-reportedoutcome measures need to be implemented in child and school health services for decision support andidentification of children at risk. We aimed to (a) qualitatively examine adjustments of active implementation fromthe pilot implementation of the Norwegian‘Starting Right’health service innovation including an online childhealth assessment tool and practical routines, and (b) measure practitioners ́ adoption and parental acceptability. Methods: We used a mixed-methods design to qualitatively examine adjustments from working notes andmeeting memoranda, and quantitatively assess adoption and acceptability from user rates provided by the systemslog. Twenty-one child and school health nurses (CSHNs) from two child health centers participated in theimplementation pilot of online health assessments in children aged 2-, 4- and 6-year. We used a deductive andnarrative analysis approach using Fixsen et al. ́s core implementation components to code and sort adjustments. Results: Core implementation components were adjusted throughout the pilot implementation. Researchers ́increased their availability in reciprocity with staff evaluation to integrate active implementation adjustments. Welaunched a project for improved data systems integration. The overall CSHNs adoption rate was satisfactory andhigher in center A, where a medical secretary supported the nurses through the entire pilot phase, than in center B(96 vs. 55 %). Parental acceptability rate was overall high (77 %) with increased rates among parents of 6-year-oldchildren (98 %) compared with younger ones (78–85 %), and in cases where both parents received thequestionnaires. Conclusions: The ‘Starting Right’ health service innovation implementation was actively adjusted by integration of core implementation components mainly based on staff evaluation. The CSHNs adopted the innovation which was also acceptable to parents.