The primary aim of the PEBBLES project (2022-2024) was to develop tools for PPT practice to assess parental beliefs and practices in parents of 0-2-year-old children.
The PEBBLES project employed a multi-method approach. Initially, a qualitative descriptive study was conducted using semi-structured interviews with both parents (n=12) and PPTs (n=12) to explore their beliefs and practices. Additionally, a survey was distributed to PPTs (n=55) to gather information on their professional beliefs. A participatory action research (PAR) approach was adopted for the design process, ensuring stakeholder engagement through collaboration between living lab PPT partners (n=6) and researchers. Multiple iterative development cycles facilitated the transfer of knowledge. The core design team included seven participants with expertise in pediatric physiotherapy, design, and research.
The qualitative analysis provided insights into the beliefs Dutch parents hold regarding their infant’s motor development and how these beliefs influence parental practices. The findings align with existing literature, which highlights cultural background as a significant factor in shaping parental beliefs. A wide variation in professional beliefs was observed among PPTs, which are primarily shaped by core values, education, and professional experience. These beliefs, often unrecognized by PPTs themselves, inform their intervention practices. It was found that PPTs rarely explore parental beliefs explicitly and rely largely on intuitive practice.
Besides knowledge, the project resulted in the development of the PEBBLES toolbox, consisting of two components: the "Book of Interest" and the "Stepping Stone Tool." These tools facilitate visualizing conversations with parents and focus on parental beliefs, practices, or the child's social context. Importantly, the toolbox is designed to be culturally sensitive. Additionally, educational materials were developed to equip PPTs with the knowledge and theoretical foundation necessary to effectively utilize the toolbox.
Given that PPTs work with families from diverse cultural backgrounds, ongoing reflection on both professional and parental beliefs is essential to ensuring equal collaboration. Involving PPTs in participatory research, such as the Living Labs model, fosters a shift in how PPTs view their professional role, particularly in their interactions with parents. This shift occurs independently of the specific tools developed. Future work should focus on evaluating the toolbox and adapting the tools to the context of parents with older children and children with chronic conditions.
The PEBBLES toolbox offers significant potential to improve clinical outcomes by promoting a collaborative, culturally sensitive, and family-centered approach. By incorporating the toolbox into educational programs, PPT educators can provide both novice and experienced practitioners with practical tools that enhance communication and family-centred care from the outset.
Early intervention
Participatory Research
