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Training community health nurses to measure parent-child interaction: A mixed-methods study

Lookup NU author(s): Dr Penny Levickis, Professor Cristina McKeanORCiD, Professor James LawORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Background: This study aims to determine whether the Parental Responsiveness Rating Scale (PaRRiS) completed at child age 24-30 months can be used by community child health nurses (CCHN) to reliably measure the quality of parent-child interactions in practice. Methods: A mixed-method design was used involving CCHNs working in public health settings. Five CCHNs recruited from the North-East of England were trained to use PaRRiS. Thirty parent-child dyads attending their routine 24-30 month check were observed. Nurses rated parent-child dyads during 5 minutes of free-play using PaRRiS. The free-play sessions were video recorded and rated blind by the first author to the nurse observation. Semi-structured phone interviews were conducted with the five CCHNs once observations of parent-child interactions were complete. Interviews were audio recorded, transcribed, anonymised and thematically analysed. Results: Two thirds of participating parents were mothers. Half the families (15/30) were from the 10% most deprived areas based on the English Index of Multiple Deprivation. The average PaRRiS score was 3.03 (SD=0.8; all ratings were <5.0). Reliability between the first author (‘gold standard’) and CCHNs was excellent (ICC: 0.85; 95%CI: 0.67 to 0.93). CCHNs found PaRRiS aligned well with current practice and was acceptable to parents. There was no evidence of a relationship between social disadvantage and PaRRiS scores. Conclusions: With further development and evaluation work, PaRRiS could potentially be incorporated into existing universal health services to provide child health nurses with an additional tool for identifying families most likely to need parent-child interaction interventions.

Publication metadata

Author(s): Levickis P, McKean C, Walls E, Law J

Publication type: Article

Publication status: Published

Journal: European Journal of Public Health

Year: 2019

Volume: 30

Issue: 3

Pages: 445-460

Print publication date: 01/06/2020

Online publication date: 20/09/2019

Acceptance date: 19/08/2019

Date deposited: 20/08/2019

ISSN (print): 1101-1262

ISSN (electronic): 1464-360X

Publisher: Oxford University Press


DOI: 10.1093/eurpub/ckz155


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