<p>Vårt syfte med denna studie är att få ökad kunskap om och förståelse för vilka upplevelser och erfarenheter de äldre själva har fått i samband med förebyggande hembesök. Metoden vi använt oss av är en kvalitativ intervjuundersökning med halvstrukturerade frågor. Studien genomfördes under hösten 2009 och sex äldre intervjuades.  Av dessa respondenter var det en man och fem kvinnor alla födda 1924.Resultatet visar tydligt att de äldre upplever att det förebyggande arbetet är mycket värdefullt för deras åldrande och vill se detta arbete fortskrida. Alla respondenter påpekade att besöket var en positiv händelse i deras liv och de fick en känsla av att någon bryr sig om dem och vet att de finns.De äldre som tackat ja till att få förebyggande hembesök påtalade att de nu vet vart de ska vända sig den dagen de är i behov av hjälp. De har med hjälp av kommunen fått information och vägledning för att klara av framtida händelser.Vår slutsats är att kommunerna med det förebyggande hembesöket som redskap hjälper de äldre att skapa bra förutsättningar för att bibehålla ett bra åldrande och fortsatt god livskvalitet.</p> / <p>The purpose of our study is to increase our knowledge of and understanding for how elderly may experience preventive home visits.To reach our purpose we have conducted qualitative interviews containing half structured questions. All of our respondents were born in 1924. Six interviews in total, with one male and five females were carried out in the autumn of 2009.The result of the study clearly indicates that the preventive work is appreciated and valuable to the elderly. They wish this kind of home visits to be continued. All respondents claimed that the visit was a positive event in their lives and they got the feeling that someone cares about them and know they exist.The elderly who accepted to receive preventive home visits claimed that they now know where to turn the day they are in need of help. They have with the municipality received information and guidance for coping with future events.Our conclusion is that preventive home care activities give elderly better conditions for satisfactory ageing and for retaining a good quality of life.</p>

Vårt syfte med denna studie är att få ökad kunskap om och förståelse för vilka upplevelser och erfarenheter de äldre själva har fått i samband med förebyggande hembesök. Metoden vi använt oss av är en kvalitativ intervjuundersökning med halvstrukturerade frågor. Studien genomfördes under hösten 2009 och sex äldre intervjuades.  Av dessa respondenter var det en man och fem kvinnor alla födda 1924.Resultatet visar tydligt att de äldre upplever att det förebyggande arbetet är mycket värdefullt för deras åldrande och vill se detta arbete fortskrida. Alla respondenter påpekade att besöket var en positiv händelse i deras liv och de fick en känsla av att någon bryr sig om dem och vet att de finns.De äldre som tackat ja till att få förebyggande hembesök påtalade att de nu vet vart de ska vända sig den dagen de är i behov av hjälp. De har med hjälp av kommunen fått information och vägledning för att klara av framtida händelser.Vår slutsats är att kommunerna med det förebyggande hembesöket som redskap hjälper de äldre att skapa bra förutsättningar för att bibehålla ett bra åldrande och fortsatt god livskvalitet. / The purpose of our study is to increase our knowledge of and understanding for how elderly may experience preventive home visits.To reach our purpose we have conducted qualitative interviews containing half structured questions. All of our respondents were born in 1924. Six interviews in total, with one male and five females were carried out in the autumn of 2009.The result of the study clearly indicates that the preventive work is appreciated and valuable to the elderly. They wish this kind of home visits to be continued. All respondents claimed that the visit was a positive event in their lives and they got the feeling that someone cares about them and know they exist.The elderly who accepted to receive preventive home visits claimed that they now know where to turn the day they are in need of help. They have with the municipality received information and guidance for coping with future events.Our conclusion is that preventive home care activities give elderly better conditions for satisfactory ageing and for retaining a good quality of life.

Background: The effectiveness of paraprofessional home-visitations on improving the circumstances of disadvantaged families is unclear. The purpose of this paper is to systematically review the effectiveness of paraprofessional home-visiting programs on developmental and health outcomes of young children from disadvantaged families. Methods: A comprehensive search of electronic databases (e.g., CINAHL PLUS, Cochrane, EMBASE, MEDLINE) from1990 through May 2012 was supplemented by reference lists to search for relevant studies. Through the use of reliable tools, studies were assessed in duplicate. English language studies of paraprofessional home-visiting programs assessing specific outcomes for children (0-6 years) from disadvantaged families were eligible for inclusion in the review. Data extraction included the characteristics of the participants, intervention, outcomes and quality of the studies. <p>Results: Studies that scored 13 or greater out of a total of 15 on the validity tool (n = 21) are the focus of this review. All studies are randomized controlled trials and most were conducted in the United States. Significant improvements to the development and health of young children as a result of a home-visiting program are noted for particular groups. These include: (a) prevention of child abuse in some cases, particularly when the intervention is initiated prenatally; (b) developmental benefits in relation to cognition and problem behaviours, and less consistently with language skills; and (c) reduced incidence of low birth weights and health problems in older children, and increased incidence of appropriate weight gain in early childhood. However, overall home-visiting programs are limited in improving the lives of socially high-risk children who live in disadvantaged families.</p> <p>Conclusions: Home visitation by paraprofessionals is an intervention that holds promise for socially high-risk families with young children. Initiating the intervention prenatally and increasing the number of visits improves development and health outcomes for particular groups of children. Future studies should consider what dose of the intervention is most beneficial and address retention issues.</p> / http://www.biomedcentral.com/1471-2458/13/17

The aim of this thesis is to contribute to existing knowledge. If the knowledge is not useful in building society it has limited value. In order to be a tool for decision-makers, Preventive Home Visits (PHVs) are described and discussed according to a realist synthesis approach. The premise of this approach is that a single trial cannot tell the whole story and that understanding theoutcome pattern is much more important than seeking regularities in results across different trials. In order to understand the o utcome pattern, the PHV strategy in Nordmaling is examined against other trials and scientific work, and also in grey literature such as reports and workingpapers. An increasing population of seniors means that resources for health and elderly care are being scrutinised in order to achieve the best possible health for the money invested. PHVs represent one strategy that attempts to promote health among independent seniors. This thesis is a multidisciplinary study aiming to gain knowledge about the effects of PHVs and to understand the mechanisms of importance when implementing this particular strategy. The point of departure is a study conducted in Nordmaling in the north of Sweden among healthy seniors aged 75 years and over. The study, conducted as a controlled trial during 2000 and 2001, showed a decrease in mortality as well as the utilisation of care, and an improvement in indicators of perceived health. Cost analyses showed significant savings for the municipality following a reduction in the use of home help. These and other savings combined with costs of the intervention were related to saved life years and used to conduct health economic analyses. Medical and social records from the primary health centre and the municipality, along with official registers provided information for modelling health economic analyses from a lifetime perspective. Results showed that the costs of PHVs were less than 10 000 Euros per gained life year, against an acceptable level of cost effectiveness of 50 000 Euros. Using a shorter time perspective, the result was even more favourable for PHVs. It was evident that the time window used in the analyses, the normative choice of including future healthcare costs or not, and how to handle the value of the seniors’ production were important factors in determining the results. Two years after the trial, in-depth interviews were conducted with 5 seniors who had experienced PHVs, in order to gain understanding of the outcome of the PHV trial in Nordmaling. Participants were selected with respect to their health and how they responded to advice given during the PHV trial. Grounded Theory was used to analyse the interviews. Seniors who used autonomous coping strategies in everyday life gained less from PHVs than other seniors. All participants could benefit from PHVs, but in order for these to be successful it was important for the home visitor to be professional and to understand how the different coping strategies of seniors worked. Taken together, the different aspects of this study raised normative questions that are discussed in this thesis. One, whether the production of seniors has any monetary value in health economic analyses conducted from a societal perspective, was addressed in a smaller diary study where 23 seniors were asked to keep a diary in order to identify everything they did over a oneweek period. It was evident that most of the respondents “produced” a lot, however the production of seniors is rarely taken into account in health economic analyses. The concept of “senior production” includes both the market value of what seniors do, as well as the value of what society can avoid doing if the seniors are independent and healthy.

Inledning: Barn i socioekonomiskt utsatta områden riskerar i större utsträckning att drabbas av psykisk ohälsa senare i livet. Kan utökade hembesök bidra till att stärka föräldraskap och tidigt upptäcka familjer i behov av stöd? Bakgrund: Barnhälsovården, mödrahälsovården och socialtjänsten i Sverige arbetar hälsofrämjande och förebyggande för att minska risken att familjer ska utveckla hälsoproblem. Mellan 2018 och 2019 genomfördes ett gemensamt projekt i två socioekonomiskt utsatta områden. Syfte: Att belysa vård-och omsorgspersonalens upplevelse av att arbeta med utökade hembesök genom projektet Förstärkt föräldraskap - utökade hembesök. Metod: Detta är en kvalitativ intervjustudie med induktiv ansats som analyserades med inspiration av kvalitativ innehållsanalys. Resultat: Resultatets tre kategorier är: Ett nytt arbetssätt som främjar samarbete och tidiga insatser, En möjlighet att fördjupa relationer och stärka föräldraskap genom hembesök samt En möjlighet att främja jämställdhet i föräldraskapet och delaktighet i familjecentralen. Diskussion: Deltagarna upplever att föräldraskapet stärkts på olika sätt genom tvärprofessionellt samarbete med utökade hembesök. Hembesöken har bidragit till stärkta relationer som givit goda förutsättningar för fortsatt samarbete och vidare kontakt med familjer. Konklusion: Deltagarna är positivt inställda och beskriver olika upplevelser i arbetet med projektet samt vad det bidragit till för verksamheterna. Kliniska implikationer: Vidare forskning rekommenderas om föräldrars upplevelser av projektet samt uppföljande studie när barnen blivit äldre.

Bakgrund: Utökade hembesöksprogram inom barnhälsovården är en relativt ny metod i Sverige som har som syfte att främja relationen mellan föräldrar och barn. Förhoppningen är även att relationen till barnhälsovårdssjuksköterska och familjestödjare stärks vilket underlättar att kontakt tas när familjen behöver det. Målet är att kunna ge det stöd som behövs till familjer vilket i sin tur påverkar barnen positivt. Det är angeläget att studera föräldrars erfarenheter av utökade hembesöksprogram för att få den kunskap som behövs för att utveckla dessa program. Syfte: Att beskriva föräldrars erfarenheter av deltagande i ett utökat hembesöksprogram på en barnhälsovårdscentral i Sverige. Metod: Metoden som användes i denna studie var kvalitativ metod med induktiv ansats. Datainsamlingen skedde genom 14 kvalitativa intervjuer med totalt 17 föräldrar som hade deltagit i utökade hembesök i projektet Tillsammans för barnen. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Resultatet visade att det utökade hembesöksprogrammet ledde till en tryggare start som förälder. Föräldrarna tyckte att de utökade hembesöken underlättade deras tillvaro, både genom att det var praktiskt att slippa åka iväg och genom att de var lugnare än besök på barnhälsovårdscentralen. Föräldrarna kände sig mer avslappnade och trygga i sin hemmiljö och upplevde att barnen kände detsamma. Föräldrarna tyckte att det var lättare att prata med barnhälsovårdssjuksköterskan och familjestödjaren när de var i sitt eget hem och vågade öppna sig mer kring sina känslor och tankar. Relationen till barnhälsovårdssjuksköterskan och till familjestödjaren upplevdes bli starkare. Föräldrarnas kunskap kring såväl barns utveckling och hälsa som barnhälsovårdens och socialtjänstens uppdrag upplevdes öka. Föräldrarnas helhetsbild av det utökade hembesöksprogrammet var positiv och många uttryckte att de önskade att utökade hembesök skulle bli standard. Slutsats: Utökade hembesöksprogram kan främja föräldrarnas relationer med sina barn och stärka relationen till barnhälsovårdssjuksköterska och familjestödjare. Hembesöken upplevdes ge ökad kunskap hos föräldrarna när det gäller barns hälsa och utveckling. De kunde också bidra till ökad kunskap om barnhälsovården och socialtjänsten. För föräldrar som var nyinflyttade i landet kunde hembesöken bidra till en ökad förståelse för det nya samhället de nu är en del av. / Background: In Sweden extended home visits are a relatively new method within the child health care with the purpose to strengthen the relationship between parent and child. The expectations are that the home visits also will strengthen the families' relationship with the child health care and the social services, thus ensuring contact is made by the parents when needed. The aim is to make sure the children and their families receive the support they need, which will have a positive impact on the children's wellbeing. Knowledge about parents' experiences of the extended home visits are vital to enable a development of the program to its fullest potential. Aim: To describe the experiences of parents who have participated in an extended homevisiting program within the child health care setting together with their children. Method: Qualitative method with an inductive approach. Interviews were analyzed with qualitative content analysis. 14 interviews were conducted with a total of 17 informants. Results: Extended home visits made the parents feel more secure. The parents thought that the extended home visits made their everyday life easier by not having to travel to the childhealth care center and that the home visits were calmer than visits to the child health carecenter. Parents felt more relaxed in their home environment and believed the same to be true for their children. The parents found it easier to talk to the child health care nurse and socialworker in their own home and to open up with regards to their feelings. The relationship with the child health care nurse and the social worker was perceived as strengthened. Parents felt that they had gained a deeper knowledge about not only the health and development of children but also about the work of the child health care and the social services. Conclusion: An extended home visiting program can strengthen the relationship between parent and child and give parents a greater sense of security in their parenthood. Home visits facilitates communication with child health care nurses and social workers and increases the parents' knowledge about a child's health and development. It can also give an increased insight in the roles of the child health care and the social services. For parents who are new to the country it can also give a deeper understanding of the society they are now a part of

In Sweden, new parents are always offered a visit from a child health care nurse. Usually the home visit takes place with only the child health care nurse. In a smaller municipality in Sweden, a decision has been made that home visits should take place in teams. The team consists of a child health care nurse and a representative from the Social Services. The aim of this study is to explore the role of emotions and emotional rules in meetings between parents, child health care nurses and representatives from the Social Services that take place in a home environment. The study also aims to investigate how emotions are shaped by the professional role (as child health care nurse and Social Services representative) as well as the place (the home of the parents). The data in the study has been gathered through a qualitative research method and eight interviews were conducted with child health care nurses as well as representatives from the Social Services. The data has been analyzed through sociology of emotions as well as Goffman's dramaturgical perspective. The results of the study shows that emotional rules and professional emotional rules are most present in the emotional labour that child health care nurses and representatives from the Social Services perform at home visits in teams. The professionals strive to convey and provide security to the new parents by adhering to emotional rules and professional emotional rules. Furthermore, it appears that the professional role and the place are of great importance for the role of emotions during home visits. Given that the meeting takes place in the private sphere of the home means that the professionals refrain from ending up in a discussion with the parents. However, they feel more comfortable having that kind of discussion at the health center.

Bakgrund: Ökade fall av barnolyckor och språkstörningar hos barn har blivit vanligare enligt forskning. BHV-sjuksköterskor i Sverige innehar nyckelrollen i det hälsofrämjande arbetet för att motverka detta. Arbetet sker i möten på barnavårdscentral och i hemmet vilket medför en samlad bild för att kunna hjälpa föräldrar i sitt föräldraskap. Forskning på BHV-sjuksköterskors upplevelser om hälsofrämjande arbete kring barnsäkerhet och språkstimulans vid åtta månaders hembesök är begränsad. Syfte: Syftet var att belysa BHV-sjuksköterskors upplevelser av hälsofrämjande arbete med fokus på barnsäkerhet och språkstimulans vid hembesök när barn är åtta månader. Metod: En deskriptiv kvalitativ studie med semistrukturerade intervjuer genomfördes med fem distriktssjuksköterskor och fyra specialistsjuksköterskor med inriktning mot hälso- och sjukvård för barn och ungdomar inom barnhälsovården. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Temat som framkom från analysen är att hembesök ger en helhetsbild som beskrivs genom tre huvudkategorier, hemmiljön katalysator för hälsosamtalet, hembesök främjar relationer och utvecklar flexibla strategier. Dessa beskrivs i åtta underkategorier. Konklusion: BHV-sjuksköterskornas upplevelser är att hembesök ger en helhetsbild av familjen som inte går att ersätta med ett besök på BVC. Huvudfokus för BHV-sjuksköterskorna är att ge individuellt stöd till hela familjen, stärka föräldraskapet och jobba hälsofrämjande för familjens hälsa, vilket är viktigt för barns framtidsutveckling. / Background: Increased cases of child accidents and language disorders in children have become more common according to research. CHC-nurses in Sweden play a key role in the health promotion work to counteract this. The work takes place in meetings at the child care center and at home to get an overview to be able to help parents in their parenting. However, research focusing on CHC-nurses' experiences of their role of health-promoting work in child safety and language stimulation during eight-month home visits is scarce. Aim: The aim of the study was to illustrate CHC-nurses` experiences of healthpromoting-work with a focus on child safety and language stimulation during home visits when children are eight months old. Methods: A descriptive qualitative study with semi-structured interviews were conducted with five district nurses` and four qualified nursing professionals specializing in the care of children from birth to adolescence working in primary health care for children. Interviews were analyzed with qualitative content analysis. Result: The theme that emerged from the analysis is that home visits provide a holistic view which is described through three main categories, the home environment is a catalyst for the health conversation, home visits promote relationships and develop flexible strategies. These are described in eight subcategories. Conclusion: The BHV nurses' experiences are that home visits provide an overall picture of the family that cannot be replaced by a visit to BVC. The main focus for the BHV nurses is to provide individual support to the whole family, to strengthen parenthood and work to promote health for the family's health, which is important for children's future development.

The purpose of this study was to find out about the presence of unannounced home visits in foster families based on a survey of Swedish municipalities. The study also aimed at increasing knowledge about why unannounced home visits were made. In order to achieve the purpose of this study, mixed methods were used in both a quantitative and qualitative approach. The quantitative part of the study consisted of a census where all Swedish municipalities' guidelines and procedures for the prevention of foster homes were collected. Qualitative interviews were held with five social services, which stated in their guidelines that unannounced home visits should be made. To analyze both the study's quantitative and qualitative results, theories of legitimacy and power were used. The study concluded that the law on follow-up of foster homes gives municipalities a large margin of interpretation because the visits are regulated by the municipalities themselves. Another conclusion from the study was that no one knows which follow-up methods that really helps. Therefore, evaluations and research on follow-up of foster care must be established.

Background: Home visits are part of general practice work in Germany. Within the context of an expanding elderly population and a decreasing number of general practitioner (GPs), open questions regarding the organisation and adequacy of GPs’ care in immobile patients remain. To answer these questions, we will conduct a representative primary data collection concerning contents and organisation of GPs’ home visits in 2014. Because this study will require considerable efforts for documentation and thus substantial involvement by participating GPs, we conducted a pilot study to see whether such a study design was feasible. Methods: We used a mixed methods design with two study arms in a sample of teaching GPs of the University Halle. The quantitative arm evaluates participating GPs and documentation of home visits. The qualitative arm focuses on reasons for non-participation for GPs who declined to take part in the pilot study. Results: Our study confirms previously observed reasons for non-response of GPs in the particular setting of home visits including lack of time and/or interest. In contrast to previous findings, monetary incentives were not crucial for GPs participation. Several factors influenced the documentation rate of home visits and resulted in a discrepancy between the numbers of home visits documented versus those actually conducted. The most frequently reported problem was related to obtaining patient consent, especially when patients were unable to provide informed consent due to cognitive deficits. Conclusions: The results of our feasibility study provide evidence for improvement of the study design and study instruments to effectively conduct a documentation-intensive study of GPs doing home visits. Improvement of instructions and questionnaire regarding time variables and assessment of the need for home visits will be carried out to increase the reliability of future data. One particularly important methodological issue yet to be resolved is how to increase the representativeness of home visit care by including the homebound patient population that is unable to provide informed consent.