The study uses a qualitative approach, and a qualitative method was applied for content analysis [17] . This method originates from structuralism and communication theory, with an epistemological basis in various scientific methods. Here, the manifest message is considered a phenomenological description, and the latent meaning is considered a hermeneutic interpretation. The method involves interpreting variations and identifying differences and similarities in the content against the background of the authors’ pre-understanding. In the analysis, the following concepts were used: meaning units, condensed meaning units, codes, subcategories, categories, and theme. In this method, categories express the manifest content of the text, while the theme expresses the latent content [18] . The study involved psychologists who conducted the training and researchers who performed the interviews and analyses. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used for reporting this study [19] .

The interviews were conducted in West Sweden. An invitation to participate was sent to a strategically selected sample of specialist nurses (n = 15) who had participated in the training for more than one year. The majority (n = 14) were interviewed. One was unable to participate due to a high workload.

The participants’ ages ranged from 35 to 65 years. All participants had specialist training, including district nurse training (n = 8) and pediatric nurse training (n = 6). All but one had worked for more than 5 years in child healthcare. At the time of the study, they were working in either private or public child healthcare clinics, some centrally located and others in rural areas. These clinics were situated in areas with varying socioeconomic structures.

Data collection was carried out in 2022 by two authors (MOT, SBP). Fourteen individual interviews were conducted using an interview guide with semi-structured questions [20] to explore participants’ experiences of the training. The interviews were conducted digitally after the educational effort was completed. Participants were interviewed at their workplaces in rooms ensuring privacy. They were asked to describe what they learned during the training and how it affected their daily work. The interviews lasted 45 to 60 minutes and were recorded and transcribed verbatim.

The interviews were analysed inductively using a qualitative content analysis method [17] . All interviews were read to understand the overall context. The text was divided into meaning units, which were then condensed without losing the core content. These condensed meaning units were labelled with codes based on their content. Codes with similar content were sorted and formulated into subcategories. In the next step of the analysis, subcategories with similar content were grouped into the same category and labelled based on the manifest content. Finally, the theme emerged based on the latent content [18] . During this process, the researchers compared the results with the original text and adjusted some wording. The four authors then critically discussed the results ( Table 1 ).

This study was approved by the Swedish Ethical Review Authority on 2021-05-24 [Dnr 2021-02780]. The ethical principles outlined in the Helsinki Declaration were followed [21] . All participants received written and oral information about the study before agreeing to participate. Each participant signed an informed consent form at the beginning of the data collection process.

The analysis reveals that implementing the educational effort requires support from operational management. Before conducting the training, certain prerequisites should be met. Digital technology must be accessible wherever the nurses are located to support the study tasks. The consultation component should be scheduled throughout the educational effort, including time for reviewing the study material. More consultation opportunities would facilitate gaining insights. The nurses justified their position by stating that the underlying theories and concepts of the model take time to learn and internalise.

“We were given tasks before each [consultation], so we knew what to read and think about. However, we didn’t have time to read, because one day, when we were scheduled at the child healthcare unit, we were suddenly needed to help with other tasks at the reception. It didn’t work. I feel like I’d have to go through the training again to grasp it all, to be honest (Nurse 1).”

More consultation opportunities were requested. The nurses expressed a strong desire for an in-depth course on the model and its application. Additionally, they urged the leadership of Child Healthcare to confirm whether the SA should be used in the continued development of Child Healthcare.

“More training opportunities are needed, as the consultations have been very useful. By the end of this year, it feels like our efforts are disappearing into the sand. I would like the support to continue indefinitely. We need to determine if the Solihull Approach is the model we should use in our work moving forward (Nurse 3).”

The study material was extensive and took time to understand and discuss, as it contains many challenging concepts that require reflection to internalize. However, the participants found it practically useful, with many good examples that explored the meaning of parental support.

“The study material was excellent. I tried to read it thoroughly, but there hasn’t been enough time to fully immerse myself in it. The discussions based on the examples presented were insightful. We must consider the importance of caring for children and parents, which may pose challenges from the perspective of the Child Healthcare Unit (Nurse 10).”

The nurses stated that the films and examples in the study material should be tailored to Swedish conditions and reflect complex situations. They recommended producing a folder that briefly describes the Solihull model for both staff and parents.

“Imagine if we could apply Solihull’s approach to parents when they face difficulties or have concerns. Perhaps a leaflet—something short and simple that reinforces what we’ve discussed, which they can take home and talk about (Nurse 2).”

The SA was implemented during consultation sessions. Through these consultations, the model’s meaning was clarified, and the consultant helped participants relate the model’s concepts to their own situations. The discussions deepened participants’ understanding of various issues that families raised during the visits. Training in asking questions rather than providing ready-made solutions helped implement the model.

“It was very developmental, like personal growth. She never told us what to do. Instead, she asked, “What are you thinking here?” It was sometimes challenging not to have a manual, but it was beneficial. Afterwards, I felt somewhat like parents might feel with the Solihull approach—figuring out the answer yourself is what helps you grow. That’s the difference between this consultation and other tutorials (Nurse 8).”

“It is important for the supervisor to guide us from theory to practice and for supervisors and colleagues to reflect our approach (Nurse 5).”

Participants stated that the SA deepens their understanding of various family issues, making it useful in interactions with parents from different cultures. Additionally, the model provided structure and depth to discussions, and the concepts were made concrete, resulting in a deepened collegial exchange of experiences.

“It took several sessions to understand the Solihull model. Initially, we discussed as we had done before. Our consultant had to remind us that the discussion must be based on the model and its concepts (Nurse 7).”

During the encounters, the consultant encouraged the nurses to relate their experiences and reactions to their own cases, as well as to the model and its central concepts. In this way, the model was put into action.

“To maintain the Solihull mindset, we discussed various concepts during each meeting. We then applied the model to our patient cases. It was important to articulate what was happening in the encounter, how we were thinking, and how Solihull supported our work at the child healthcare unit (Nurse 11).”

The nurses mentioned they had changed their way of working. They focused more on the fact that families have different needs rather than giving general advice. They became more observant of the interaction between parents and children, developed a more family-centred approach, and adapted their methods to families’ needs and situations.

“It’s taken some of the burden off my shoulders because I feel like I don’t have to solve the family’s problems right away. Now, I act more like a sounding board, helping the family move forward. It’s more of a process than going from A to B. It is a winding road, and I guide them along the way. It’s good (Nurse 12).”

The model has made the nurses’ work easier. Instead of giving advice, they ask open-ended questions that encourage parents to reflect and suggest solutions that suit their family.

“I used to be quick to give a lot of advice, but I’m not anymore. I think it is more important to start a dialogue and discussion about how they think. Now, I ask more open-ended questions and let the parents describe the situation and come up with their answers (Nurse 13).”

“My task is to first sow the seed of a small thought. Instead of solving the problem on this visit, I must follow up on it on several occasions. It needs to resonate with the parents I meet (Nurse 9).”

Through educational efforts, participants became more observant of how parents and children interact during the visit.

“Previously, when a connection did not work, it was unclear what certain connection patterns indicated. However, with this model, it has become clearer. I have learned to better interpret the interactions and understand what a child’s difficulties may be due to (Nurse 14).”

“I pay close attention to the child’s behaviour and the parents’ interactions, including how they comfort or don’t comfort the child and whether they make eye contact with the child. I find an approach for a conversation, even if the parents do not specifically mention this issue (Nurse 8).”

The training helped nurses focus on the children’s perspective instead of parents’ frustrations and boundary-setting issues. They emphasized helping parents understand their children and their reactions. Nurses learned to empower parents in their parental role and to understand the children’s perspective.

“Setting boundaries is difficult. It’s easier to discuss being straightforward and setting limits when a child throws a tantrum. However, if someone is harsh with their child, I think it’s more challenging to discuss (Nurse 2).”

“If the parents are weak, I usually ask if they think the child should always get what they want and what causes the child to react with tantrums. This is something Solihull has taught me, and it has been incredibly rewarding (Nurse 5).”

The analysis aimed to highlight specialist nurses’ experiences with an evidence-based working model in child healthcare. After analysing 14 interviews, no new perceptions emerged to develop existing codes, subcategories, and categories. Credibility and validity are based on the transparency of the research process presented in this article. We recruited a strategic sample of specialist nurses who participated in the training (n = 14). They were knowledgeable and willing to share their experiences about the training’s advantages and disadvantages [20] . They provided several examples of how the training affected their professional practice and suggested ways to simplify, improve, and incorporate the training into regular work.

To evaluate the accuracy of the findings, four criteria—credibility, dependability, confirmability, and transferability—were used [22] . To achieve credibility, data were collected from all participants. After collecting relevant data and conducting interviews, all authors’ opinions were used to confirm the accuracy of the coding process. The researchers improved the validity of their findings by allocating sufficient time for prolonged engagement with the data and by following a step-by-step data analysis process. The opinions of two experts were also used to check the accuracy of the categories, data analysis, and extraction process. To allow the research to be audited, the research steps were carefully recorded. Detailed descriptions of the participants were provided to enable the transferability of the findings to similar contexts, situations, and individuals [23] .

The study shows that participants’ attitudes and values shifted towards a more person-centred and relationship-oriented approach in every encounter with parents and children. Participants stated they reflected more on the importance of interaction, which increased their awareness and observational abilities. Previous evaluations of the educational effort indicate similar findings [15] .

The Solihull Approach (SA) was introduced through two half-day sessions, which included lectures, presentations of educational material, and reflection exercises. The goal was to reinforce the value of focusing on strengthening parental skills and to highlight the importance of interaction in the parent-child relationship. The training continued in consultation groups for a year with a child health psychologist.

The results suggest the study material could be improved by concretizing theoretical concepts through case descriptions. The SA is theoretically extensive and was found by some participants to be time-consuming to understand. The model requires repeated training sessions and reinforcement of basic concepts and their meanings. Participants reported difficulties due to the lack of a manual with practical guidance and ready-made solutions. Specialist nurses expressed a need for a leaflet about the SA to distribute to parents. The consultation sessions, where participants discussed and applied the theories, were the most significant part of the SA. During these sessions, participants reflected on their experiences and communicated how they applied the SA.

The consultation was the main part of the educational effort, where the work material was developed. Theory was integrated into practical application. During the consultation, the specialist nurses reflected on their own experiences and how they could apply the model. This form of learning, where participants connect theory to practice and reflect on their actions, facilitates the integration of knowledge.

In the training and implementation of the SA, consultation is vital and necessary. Due to the COVID-19 pandemic, consultations often had to be conducted digitally. This was accompanied by challenges such as a lack of technical equipment and a loss of multidimensional interactions. In some cases, staff shortages required nurses to switch to other tasks. Participants indicated that training should be scheduled over a year, with consultations planned with a psychologist. Without continuous consultation, the working method cannot be implemented in child healthcare. Consultation is essential for competence development and quality assurance in child healthcare. The interviews highlighted the importance of operational managers understanding the model to enable staff to fully implement the educational effort. Conducting a longitudinal process evaluation using both quantitative and qualitative methods would be valuable to assess the educational effort’s impact on developing evidence-based child healthcare.

The goal of this educational effort by specialist nurses is to create a consensus and understanding of the importance of working with parental support in each and every encounter with parents and children. Parental support aims to strengthen parents’ ability to meet their children’s emotional, cognitive, and social needs. Winnicott [24] emphasizes the critical role of parenthood in children’s development and living conditions, as well as the environment’s influence on a child’s ego development. Empowering parents can lead to long-term societal benefits through improved living conditions for children and can reduce the need for societal interventions.

This study shows that educational efforts have led to a more person-centred and relationship-oriented approach with parents and children. To promote competence development for specialist nurses in Child Healthcare, continuous education on the SA is recommended for all employees. We propose including the model in the basic and further education of specialist nurses. Operational management is responsible for implementing and maintaining work according to the model. The evaluation of the Solihull model has led to further development of educational efforts, including digital interactive materials intended for a training package for specialist nurses in child healthcare. Implementation of the SA approach is currently in progress, and the SA model will be researched longitudinally.