Understanding Vulnerability During Preventive Child Health Examinations: Insights from Danish General Practitioners

BACKGROUND/OBJECTIVES: Child vulnerability is a predictor for potentially adverse challenges for the child and family, but the term is used inconsistently across settings. Danish general practitioners (GPs) are centrally positioned as the front line of the health care system. Thus, the aim of this study is to explore Danish GPs' perspectives and assessment of child vulnerability, using an exploratory, sequential mixed-methods approach. METHODS: Eleven GPs were interviewed, focusing on perceptions and management of child vulnerability in the context of preventive child health examinations (PCHEs). Interviews were analyzed in two stages. From the first deductive analysis, a quantitative data recording chart was developed. This was distributed to 10 general practices, to collect GPs' perceptions and management of child vulnerability, and 197 recordings were completed. Secondly, to develop themes independently of the deductive coding, data was analyzed inductively, creating an in-depth understanding of GPs' perspectives. This resulted in four themes. RESULTS: GPs associated the concept of child vulnerability with a multitude of social, somatic, and psychological factors. To recognize child vulnerability, GPs found time and scope during PCHEs limited and knowledge of the family essential. Collaboration with social services was perceived as insufficient. The most frequent finding during PCHEs was related to somatic challenges (60%) and follow-up consultation was the most frequent response (64%). CONCLUSIONS: GPs considered child vulnerability a complex term. Assessment of child vulnerability was strongly related to knowledge of the family, and usually based on several consultations, which underscores that PCHEs represent only one of several contexts where concerns are assessed and addressed.