Organizational differences in early child health care -- mothers' and nurses' experiences of the services.

Aim: The aim of this study was to evaluate parents' and nurses' perceptions of the child health services (CHS) in relation to whether the nurse worked exclusively with children (focused-child health centre, CHC) vs. with people of all ages (mixed-CHC).

Method: Information about parents' perceptions about the CHS was acquired by a questionnaire intended for the mothers of 18-month-old children. One thousand thirty-nine answered in the baseline 2002-2003 and 996 in the follow-up 2004-2005. The nurses answered a special questionnaire aimed to obtain knowledge about their satisfaction with their work. Eighteen CHCs were chosen from the county of Uppsala and eighteen from other Swedish counties. The CHCs were chosen from areas with poor psycho-social status. The data were collected by questionnaires to mothers and nurses, and the analysis used the chi-square test, t-test and logistic regression. The study was approved by the Research Ethics Committees of the universities involved.

Results: Mothers were more satisfied, and the nurses found their work tasks easier, at CHCs where the child health nurse worked exclusively with children, compared with mothers and nurses belonging to CHCs where the nurses provided care to people of all ages.

Conclusion: The findings indicated that nurses working exclusively with children, being able to concentrate their time and knowledge on a specialized field, develop a more solid child health competence. There are strong reasons to consider introducing 'exclusive' CHCs in psycho-socially vulnerable areas, which would probably make the services more effective. However, intensified education may modify the drawbacks of mixed-CHCs.