Author: Dimity Dutch
Dutch, Dimity, 2025 Embedding children’s health behaviour screening within routine primary health care as a strategy to support growth, health, and development in the early years, Flinders University, College of Nursing and Health Sciences
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Background
The first five years of life is a critical life stage of development, laying the foundation for lifelong health and wellbeing. During this time, children’s modifiable health behaviours are established, including dietary intake, physical activity, sedentary behaviour, and sleep habits. These health behaviours can track into adolescence and adulthood, influencing health across the life course. The early years is therefore a critical time in which caregivers and health practitioners can support a child’s growth, health, and development. Caregivers of young children frequently access Primary Health Care (PHC) providing an ideal setting and opportunity for early intervention and health promotion. Current recommended practice within PHC is to use growth-related measures, including height and weight, as a proxy measure for health. However, there can be substantial barriers to this approach including caregiver receptiveness, stigma, and impact on rapport. Pilot studies conducted internationally show that screening for a child’s health behaviours in PHC is feasible accepted by caregivers and practitioners. However, the suitability of this approach within the Australian PHC system is unknown.
Thesis Aim
The aim of this thesis was to determine the feasibility and acceptability of embedding child health behaviour screening within routine Primary Health Care (PHC) as a strategy to support growth, health, and development in the early years (birth to five years).
Methods and Results
The epistemological framework to address the thesis aim was pragmatism. Pragmatism is a flexible and reflexive approach to research design, embracing both quantitative and qualitative methods. Pragmatism recognises that knowledge is both real and constructed, and is influenced by real-world experiences. Therefore, pragmatism provides the epistemological justification to inform the multi-method approach utilised in this thesis.
Study 1 was a scoping review of Australian PHC guidelines (n = 18) which aimed to identify and describe current advice and recommendations to support optimal growth, health, and development of children in the early years (birth to five years). The review demonstrated that Australian PHC guidelines recognise the importance of monitoring and promoting child health behaviours in routine PHC, however there is currently a lack of practical guidance, tools, and resources to support practitioners to do this in practice.
Study 2 was a systematic review of existing child health behaviour screening tools (n = 14) used in PHC settings internationally. Review findings indicate that child health behaviour screening tools exist, and are acceptable and feasible in PHC, however none have been tested in an Australian PHC setting.
Study 3 involved workshops (n = 9) with PHC practitioners (n = 29) following the Nominal Group Technique (NGT) approach to identify and prioritise key features of a child health behaviour screening tool and the supports needed to implement child health behaviour screening in PHC. Workshop findings demonstrate South Australian PHC practitioners are accepting of a child health behaviour screening, indicating that the tool must be easy to complete and understand, use inclusive and accessible language, and be appropriate for use across disciplines and sectors.
Study 4 was a multi-method pilot study which aimed to understand caregiver acceptability and feasibility of a child health behaviour screening tool within a multi-disciplinary PHC clinic. Survey and interview data demonstrate Australian caregivers are accepting of a brief electronic child health behaviour screening tool conducted in the waiting room prior to a PHC visit. Caregivers are interested in receiving screening tool results, as well as tailored health information, resources, and referrals following screening to support their child's growth, health, and development.
Conclusion
This research proposed a new universal and strengths-based approach to early intervention in the first five years of life, by testing the use of a child health behaviour screening tool in routine PHC. The findings of this thesis demonstrate alignment of child health behaviour screening with Australian policy, guidelines, and practice. This research generated new knowledge of the feasibility and acceptability of child health behaviour screening in Australian PHC, achieving the thesis aim, and contributing to the evidence base to take forward in future studies to establish effectiveness, initiating the path towards a change in PHC practice.
Keywords: early childhood, health promotion, primary health care, health behaviours
Subject: Nutrition thesis
Thesis type: Doctor of Philosophy
Completed: 2025
School: College of Nursing and Health Sciences
Supervisor: Professor Rebecca Golley