Hälsovägledning i barnhälsovården : syntetisering av två uppdrag

Child Health Services (CHS) form a strategic arena for Swedish health promotion, from a societal as well as individual perspective. The present study focuses on district nurses´ health counselling in CHS. The aim is to improve understanding of what is important in shaping and accomplishing health promotion, and to generate theory useful in a CHS context. Data were collected at CHS in primary health care. Data sources consist of video-observations with recalled interviews of seven district nurses’ meetings with parents and children during open consultations, field notes, notes from group discussions and individual interviews. Data from findings in my earlier study of health counselling in CHS were also used. Data analysis followed the classic Grounded Theory (GT) method. In accordance with GT, concepts and categories were integral parts of a constant comparative analysis. Empirical data indicated that health promotion in CHS has two approaches, a population approach and an individual approach. District nurses thus have two missions: a public health mission (a government demand based on families as parts of the population), and a family health mission (a request from individual families). District nurses' main concern in CHS is to synthesise these two opposing missions and approaches in their practical work at the CHC (Child Health Centres). The category Population-individualisation evolved as the core category. Subcategories are Two-facedness, Individualisation efforts, Normality focus, Case record concern, Communication staging and Action scope promoting. Four dynamic fields between public and family health missions evolved. One is the Population-individualisation field in which general concerns for public health are combined with considering the needs of the specific family. The other fields were labelled Individual support, Population inspection and Routine check-up. Four patterns for synthesis evolved. One is a Hypothetical ideal proceeding. This is a synthesis where both approaches are equally strong. Three patterns with oscillatory movements were evident in praxis: a Sig-sagging pattern with small oscillating movements, a Pendulating pattern with longer movements and a Compensating pattern with different movements compensating each other. Through the generating analysis a substantive theory could be formulated. The generated theory grounded in empirical data within the context of CHS provides us with knowledge that can help district nurses understand and manage their main concern for synthesising these two missions. This theory may also contribute to increased awareness among administrators, decision makers and nurse- and health promotion educators with regard to the double mission in health promotion and the strategies for coping with it. In this way, generated theory should be able to contribute to improve health promotion and health counselling in CHS