Open Access Open Badges Research article

Improving child health promotion practices in multiple sectors – outcomes of the Swedish Salut Programme

Kristina Edvardsson12*, Anneli Ivarsson1, Rickard Garvare3, Eva Eurenius1, Marie Lindkvist14, Ingrid Mogren5, Rhonda Small2 and Monica E Nyström16

Author affiliations

1 Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 901 87, Umeå, Sweden

2 Mother and Child Health Research, La Trobe University, Melbourne, Vic, 3000, Australia

3 Division of Quality Management, Luleå University of Technology, SE 971 87, Luleå, Sweden

4 Department of Statistics, Umeå University, SE 90187, Umeå, Sweden

5 Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, SE 901 87, Umeå, Sweden

6 Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden

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Citation and License

BMC Public Health 2012, 12:920  doi:10.1186/1471-2458-12-920

Published: 30 October 2012



To improve health in the population, public health interventions must be successfully implemented within organisations, requiring behaviour change in health service providers as well as in the target population group. Such behavioural change is seldom easily achieved. The purpose of this study was to examine the outcomes of a child health promotion programme (The Salut Programme) on professionals’ self-reported health promotion practices, and to investigate perceived facilitators and barriers for programme implementation.


A before-and-after design was used to measure programme outcomes, and qualitative data on implementation facilitators and barriers were collected on two occasions during the implementation process. The sample included professionals in antenatal care, child health care, dental services and open pre-schools (n=144 pre-implementation) in 13 out of 15 municipalities in a Swedish county. Response rates ranged between 81% and 96% at the four measurement points.


Self-reported health promotion practices and collaboration were improved in all sectors at follow up. Significant changes included: 1) an increase in the extent to which midwives in antenatal care raised issues related to men’s violence against women, 2) an increase in the extent to which several lifestyle topics were raised with parents/clients in child health care and dental services, 3) an increased use of motivational interviewing (MI) and separate ‘fathers visits’ in child health care 4) improvements in the supply of healthy snacks and beverages in open pre-schools and 5) increased collaboration between sectors. Main facilitators for programme implementation included cross-sectoral collaboration and sector-specific work manuals/questionnaires for use as support in everyday practice. Main barriers included high workload, and shortage of time and staff.


This multisectoral programme for health promotion, based on sector-specific intervention packages developed and tested by end users, and introduced via interactive multisectoral seminars, shows potential for improving health promotion practices and collaboration across sectors. Consideration of the key facilitators and barriers for programme implementation as highlighted in this study can inform future improvement efforts.

Antenatal care; Change barriers; Change facilitators; Child health care; Complex interventions; Dental health services; Health promotion; Implementation; Prevention; Primary health care