Evaluation of a Child Health Care Program for Early Identification of Family Violence

The aim of this mixed methods study is to gain knowledge about how a program for identification of family violence works within child health services. The main research questions are:

• To what extent are questions about family violence asked to mothers and fathers visiting the child health services in the Region of Stockholm?
• How can area level socioeconomic factors affect whether parents are asked questions about family violence in the child health services?
• How do child health nurses experience asking parents about family violence?What challenges and opportunities do they meet when they identify family violence?

Study Overview

• Status: Not yet recruiting
• Conditions: Identification of Family Violence
• Intervention / Treatment: Other: Registry review; Other: Interviews

Detailed Description

Being exposed to family violence (FV) as a child is associated with an increased risk of negative impact on development and health both in the short and long term. Research shows that FV occurs in all cultures and in all social classes. However, there is an increased risk of FV in areas with a higher degree of social vulnerability. For children, FV means being directly exposed to psychological, physical, sexual violence or neglect. It can also mean experiencing violence between adults in the home, which leads to the same negative consequences for the child. Parents with current or previous experiences with FV have an increased risk of difficulties in parenting skills, which in turn can affect the child negatively.

In Sweden, almost all children 0-5 years old are enrolled in the child health services (CHS). As part of the CHS-program, all parents are offered an individual visit within the first six months of their child's life to address parenting topics and parental mental health. Questions about FV are asked during that individual visit. The CHS thus has a unique opportunity to detect FV in the family at an early stage in the child's life.

This mixed methods study evaluates how a program for identification of family violence works within child health services. The quantitative part is a registry based observational study to investigate the extent to which both mothers and fathers are given the opportunity to respond to questions about FV within CHS in the Stockholm region. Furthermore, it examines whether there is an association between being asked about exposure to violence and the socioeconomic status of the catchment areas of CHS centers. The qualitative data consist of interviews with child health nurses.

De-identified medical record data regarding questions about family violence addressed to the child's parents will be collected from approximately 90,000 child records at the CHS centers. Included CHS centers are located in areas with different socioeconomic status. Data cover the period 240630-250630. Background data on the organizational conditions (number of employees, training to identify FV) of the included CHS centers are also obtained. The results are also measured based on the clinic's sociodemographic, according to the Care Need Index (CNI). The data enables comparisons between different CHS centers, and the interviews contributes to an in-depth analysis of the study's results based on varying contextual factors that may assist or hinder the identification of FV.

• Study Type: Observational
• Enrollment (Estimated): 90000

Contacts and Locations

• Study Contact: Name: Anna Frojlinger, PhD student; Phone Number: +46725993554; Email: anna.frojlinger@ki.se

Study Locations

• Sweden
  • Stockholm County
    • Stockholm, Stockholm County, Sweden, S-10431
      • Region Stockholm

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The population are parents to children enrolled in CHS in the Stockholm region and nurses working in CHS in the Stockholm region

Description

Inclusion Criteria:

• Parents to children enrolled in the CHS
• Child health nurse working at one of the included CHS centers

Exclusion Criteria:

-

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Parents; Parents of children enrolled in child health services	Other: Registry review; The study is set within a project to evaluate a program for identification of family violence. The study uses mixed methods including registry review of parents to evaluate the effect of the program.
Nurses; Nurses working within child health services	Other: Interviews; The study is set within a project to evaluate a program for identification of family violence. The study uses mixed methods including interviews with nurses to evaluate the effect of the program.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Parents being asked about family violence according to patient records	Mothers and fathers who have been asked about family violence at the child health services according to the child's patient record (yes/no)	1 year
Nurses experiences of opportunities and challenges in the work around family violence identified through qualitative assessments	Nurses are asked about opportunities and challenges to pose questions about family violence. They are invited to share their experiences about identifying family violence and offering support.	Time since the program was implemented, between three and five years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Identification of family violence documented in patient records	Identification of family violence among parents and children enrolled at the CHS (yes/no)	1 year
Reports to the social services documented in patient records	Reports to the social services filed by nurses due to identified family violence documented in patient records	1 year

Collaborators and Investigators

• Sponsor: Karolinska Institutet
• Collaborators: Forte: Swedish research council for health, working life and welfare
• Investigators: Principal Investigator: Lene Lindberg, Professor, Karolinska Institutet: Department of Global Public Health

Study record dates

Study Major Dates

• Study Start (Estimated): October 1, 2025
• Primary Completion (Estimated): December 31, 2027
• Study Completion (Estimated): December 31, 2028

Study Registration Dates

• First Submitted: August 20, 2025
• First Submitted That Met QC Criteria: August 28, 2025
• First Posted (Estimated): September 8, 2025

Study Record Updates

• Last Update Posted (Estimated): September 8, 2025
• Last Update Submitted That Met QC Criteria: August 28, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Keywords: Primary health care; Evaluation; Screening; Identification; Parental support; Family violence
• Additional Relevant MeSH Terms: Health Care Quality, Access, and Evaluation; Investigative Techniques; Epidemiologic Methods; Data Collection; Health Care Evaluation Mechanisms; Quality of Health Care; Public Health; Environment and Public Health; Interviews as Topic
• Other Study ID Numbers: FRIDA

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: IDP are not avialable due to the ethical approval. Access to data requires ethical approval and could then be provided upon request.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No