Evidence map›Paper›PMID 39026201›Full record

ArticleBMC pediatrics2024

Opening Pandora's box - key facilitators of practice change in detecting and responding to childhood adversity - a practitioner perspective.

Sarah Loveday, Lingling Chen, Leanne N Constable, Ashraful Kabir, Natalie White, Sharon Goldfeld, Lena Sanci, Harriet Hiscock

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC pediatrics, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Sarah LovedayDepartment of Paediatrics, University of Melbourne, Parkville, VIC, Australia. sjloveday@student.unimelb.edu.au.ORCID http://orcid.org/0000-0001-6512-8900
Lingling ChenHealth Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia.ORCID http://orcid.org/0000-0003-3435-1282
Leanne N ConstableHealth Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Ashraful KabirHealth Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia.ORCID http://orcid.org/0000-0002-5597-6065
Natalie WhitePolicy and Equity, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Sharon GoldfeldDepartment of Paediatrics, University of Melbourne, Parkville, VIC, Australia.ORCID http://orcid.org/0000-0001-6520-7094
Lena SanciDepartment of General Practice, University of Melbourne, Parkville, VIC, Australia.ORCID http://orcid.org/0000-0003-4834-4737
Harriet HiscockDepartment of Paediatrics, University of Melbourne, Parkville, VIC, Australia.ORCID http://orcid.org/0000-0003-3017-2770

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundChildhood adversities worsen physical and mental health across the lifespan. Health and social care practitioners play a key role in identifying and responding to childhood adversity, however, may be reluctant to do so due to a perceived lack of services to refer to, time pressures and a deficit of training and confidence. We aimed to (1) quantify changes in practitioner comfort and confidence to identify and respond to childhood adversity following a multimodal intervention within an integrated child and family health and social care hub and (2) to understand barriers and facilitators of practice change.

methodsHub practitioners were surveyed about their competence and comfort to directly ask about and confidence to respond to adversity at baseline and then at six and twelve months post training. Interviews were undertaken to explore practitioner barriers and enablers of practice change. Interviews were recorded, transcribed verbatim, and analysed using reflexive thematic analysis. The theoretical domains framework was used to identify the key drivers of practice change.

resultsFifteen of 18 practitioners completed all three surveys and 70% reported increased competence and comfort to directly ask, and confidence to respond across a range of adversities over the 12-month intervention. Twenty-one practitioners completed interviews. Six themes were identified as either facilitators or barriers to practice change. Facilitator themes included (1) connection matters, (2) knowledge provides assurance, (3) confidence in ability and (4) choosing change. Barrier themes were (1) never enough time and (2) opening Pandora's box. Following analysis, key drivers of practice change were 'social influence', 'belief in capability', 'knowledge' and 'behaviour regulation' while barriers to practice change were 'environmental context and resources' and 'emotion'.

conclusionsPractitioners reported improved confidence in identifying and responding to adversity through a multimodal intervention delivered in an integrated Child and Family Hub. Changing practice requires more than just education and training. Opportunities for social connection and coaching to improve self-confidence and perceived competence are needed to overcome the fear of opening Pandora's box.

Indexed as

Adverse Childhood ExperiencesClinical CompetenceAttitude of Health PersonnelChildChild Health ServicesFemaleHumansInterviews as TopicMaleQualitative ResearchChildhood adversityIntegrated carePractice changeQualitative research

Identifiers

PMID39026201
PMCPMC11256471

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.