Astudillo D1, Castro-Avila AC1,2, Leppe J1
1Universidad del Desarrollo, School of Physical Therapy, Santiago, Chile, 2University of York, Department of Health Sciences, York, United Kingdom
Background: Early childhood is a critical period since adverse exposures and experiences increase the risk of poor social, cognitive, and health outcomes. Evidence suggests that intervention such as care for child development, skilled birth attendance, exclusive breastfeeding, and immunisations can help improve children's health and promote nurturing care. In Chile, several policies have been implemented in this area, but it is not clear to what extent they are effective, what research gaps exist and what role physiotherapists have.
Purpose: To identify policies for promoting child development and maternal health in force in Chile, determine which ones are effective, what role the physiotherapist has, and potential research gaps.
Methods: Scoping review following the Joanna Briggs Institute methodology. MEDLINE and Scielo were searched using MeSH terms and free text using synonyms for “health policy” and “child development”. A second search was conducted in google scholar, websites of international organisations (e.g. WHO, UNICEF, UNESCO, OPS, ECLAC) and Chilean Ministries to identify grey literature. One researcher (DA) conducted the search and initial screening, while a second one (ACCA or JL) checked for consistency. The inclusion criteria were government programmes for promoting the development of children under 5 years old in Chile. We extracted information on each programme regarding its aim, risk factors that addressed, whether physiotherapist had a role in its implementation, whether it has been evaluated, and the strengths and weaknesses identified in those evaluations.
Results: The initial search identified 2060 documents of which 72 met the inclusion criteria, describing 59 eligible programmes. Twenty-one (36%) programmes aimed at improving social protection, 17 (29%) focused on education, 14 (24%) on health and wellbeing, and eight (12%) consisted on subsidies (e.g. Subsidy for unemployed pregnant women). The most commonly addressed risk factor was inadequate opportunities for learning in the home (30 programmes) followed by insensitive or non-responsive caregiving (25), economic constraints (19), and child maltreatment (abuse or neglect) (13). Six programmes (10%) included physiotherapists in their delivery, which focused on interventions for delayed motor development of vulnerable children or promoting physical activity. Twenty-eight evaluations of 21 (36%) programmes had been performed with most of them (71%) focusing on how implementation had been achieved. The National immunisation programme was the most effective one. The major area of weakness was the monitoring of performance and outcomes for beneficiaries, which were also the areas identified as research gaps.
Conclusion(s): Physiotherapists have a role in few policies for child development and maternal health. Their role is linked to the recovery of motor function and rarely to promoting healthy development through physical activity.
Implications: Although international evidence supports the interventions being implemented, local evidence is lacking. This prevents effective monitoring and policy decision-making. Physiotherapists could have a greater role in promoting the healthy motor development of children and a more active lifestyle of their parents. This could be achieved by training professionals who engage with them in critical periods of life such as midwives during antenatal check-ups, nurses in healthy child visits, and early years teachers in nurseries.
Keywords: Public policies, Infant, child development
Funding acknowledgements: None
Purpose: To identify policies for promoting child development and maternal health in force in Chile, determine which ones are effective, what role the physiotherapist has, and potential research gaps.
Methods: Scoping review following the Joanna Briggs Institute methodology. MEDLINE and Scielo were searched using MeSH terms and free text using synonyms for “health policy” and “child development”. A second search was conducted in google scholar, websites of international organisations (e.g. WHO, UNICEF, UNESCO, OPS, ECLAC) and Chilean Ministries to identify grey literature. One researcher (DA) conducted the search and initial screening, while a second one (ACCA or JL) checked for consistency. The inclusion criteria were government programmes for promoting the development of children under 5 years old in Chile. We extracted information on each programme regarding its aim, risk factors that addressed, whether physiotherapist had a role in its implementation, whether it has been evaluated, and the strengths and weaknesses identified in those evaluations.
Results: The initial search identified 2060 documents of which 72 met the inclusion criteria, describing 59 eligible programmes. Twenty-one (36%) programmes aimed at improving social protection, 17 (29%) focused on education, 14 (24%) on health and wellbeing, and eight (12%) consisted on subsidies (e.g. Subsidy for unemployed pregnant women). The most commonly addressed risk factor was inadequate opportunities for learning in the home (30 programmes) followed by insensitive or non-responsive caregiving (25), economic constraints (19), and child maltreatment (abuse or neglect) (13). Six programmes (10%) included physiotherapists in their delivery, which focused on interventions for delayed motor development of vulnerable children or promoting physical activity. Twenty-eight evaluations of 21 (36%) programmes had been performed with most of them (71%) focusing on how implementation had been achieved. The National immunisation programme was the most effective one. The major area of weakness was the monitoring of performance and outcomes for beneficiaries, which were also the areas identified as research gaps.
Conclusion(s): Physiotherapists have a role in few policies for child development and maternal health. Their role is linked to the recovery of motor function and rarely to promoting healthy development through physical activity.
Implications: Although international evidence supports the interventions being implemented, local evidence is lacking. This prevents effective monitoring and policy decision-making. Physiotherapists could have a greater role in promoting the healthy motor development of children and a more active lifestyle of their parents. This could be achieved by training professionals who engage with them in critical periods of life such as midwives during antenatal check-ups, nurses in healthy child visits, and early years teachers in nurseries.
Keywords: Public policies, Infant, child development
Funding acknowledgements: None
Topic: Globalisation: health systems, policies & strategies; Service delivery/emerging roles
Ethics approval required: No
Institution: Universidad del Desarrollo Clínica Alemana
Ethics committee: Facultad de Medicina
Reason not required: Use of information publicly available.
All authors, affiliations and abstracts have been published as submitted.
