Terveydenhoitajat liikunnanedistäjinä lastenneuvolatyössä

This qualitative research, based on public health nurses’ experiences and views, explores physical activity promotion as part of primary health care for children below school age. The aims of the original publications (II-IV) underlying this thesis were, firstly, to explore how public health nurses working in child health clinics approach physical activity, secondly, to describe physical activity promotion in child health clinic practice, and thirdly, to specify determinants of physical activity promotion.The main data were gathered in spring 2003 by a purposive sample of 24 nurses in five regional focus groups, providing lively interaction between nurses. In all, 92.3% of the invited nurses participated. The focus group guide was based on a preliminary study (I). The sample consisted of professionally experienced [mean 13.9 years], female [mean 46.2 years] nurses with some training in health-enhancing physical activity. Frame analysis of transcripts revealed that nurses approached physical activity from the environmental frame, the family frame, the natural frame, and the well-being and health frame. After analysing nurses’ concrete statements (N=223) related to physical activity promotion by qualitative content analyses and after computing the frequencies, either evaluative or activating and supportive statements could be observed. In all, 78% of these statements were child-centred. Family-centred statements focused on a family member, usually the mother, rarely on the whole family. According to group discussions, child-centred evaluation provided by public health nurses dealt with motor development and fundamental motor skills [i.e., physical abilities], as well as with play, outdoor activities, and exercising habits [i.e., physical activities]. Family-centred evaluation dealt with general activity level of the family and family’s resources for physical activity. Furthermore, activation and support included the same topics brought up during check-ups, as a basis for counselling, or infrequently, for reinforcement. Forcefulness of statements showed that assessment of physical abilities was the only topic applied with every child. Other topics were more selectively targeted for children with additional needs, e.g. overweight and clumsiness, concurrently implying a more curative approach to health promotion. Issues related to the personal characteristics and abilities of public health nurses, the nature of child health clinic work, and collaboration as well as information on service-delivery in physical activity were listed as determinants of physical activity promotion.Rural nurses seemed to have the best options for individualized physical activity promotion thanks to better knowledge of their clients. Finally, findings from this explorative study are provided in an ‘opportunistic’ model depicting physical activity promotion in child health clinics. However, nurses’ multidimensional approaches did not explicitly turn into reality in routines with every child and family.Therefore, regarding preventive and promotional issues, more emphasis should be placed on the physical activity of every child and physical activity of the whole family. Research and development actions are warranted in order to facilitate future efforts of health professionals to meet the growing needs of physical activity promotion in nursing practice with young families with children.