# ‘Saga Stories in health talks’ for health promotion in Swedish child healthcare: results from a cluster-randomised hybrid type 1 effectiveness-implementation study

## TL;DR

A study evaluated a health promotion tool for Swedish child healthcare but found no significant impact on parents' confidence or children's healthy behaviors.

## Contribution

The study introduces a novel health communication tool for child healthcare and evaluates its real-world implementation and effectiveness.

## Key findings

- The SSiHT material was used in 83% of health talks and deemed feasible and appropriate by nurses.
- No significant effects were observed on parental self-efficacy or children's health behaviors.
- The intervention was well accepted but did not lead to measurable improvements in health outcomes.

## Abstract

Early-life interventions are essential for improving public health since lifestyle behaviours are established already in childhood. Child healthcare (CHC) plays a crucial role in this context. The ‘Saga Stories in health talk’ (SSiHT) material includes a flipchart with colourful illustrations to facilitate CHC nurses’ routine health talks with parents and their children, and a hand-out material kit to support healthy lifestyle behaviours in the families. Our aim was to evaluate the effectiveness of the SSiHT intervention at the 5-year routine visit at CHC on parental self-efficacy (primary outcome) and children’s health-related behaviours (secondary outcomes). Implementation aspects for using the SSiHT material in routine practice for health talks at the 5-year visit were simultaneously evaluated.

A hybrid type 1 effectiveness-implementation design was used to evaluate the intervention in six health regions across Sweden. A cluster-randomised controlled trial was conducted to evaluate effectiveness, where 40 CHC centres (98 nurses) were randomised into two arms: use the SSiHT material in routine care (intervention), or standard care (control). Parents (n = 698) of 5-year-olds were recruited. Outcome measures were assessed using digital questionnaires before the health talk (baseline), and two months later (follow-up). Linear mixed-effect models were used to contrast differences in outcomes between groups, in accordance with the study protocol. Acceptability, appropriateness, feasibility, fidelity, and adoption were evaluated using questionnaires and checklists to CHC nurses in the intervention group.

No statistically significant intervention effects were found on parental self-efficacy to promote healthy lifestyle behaviours in their children (-0.61 score on a scale 0–160; p = 0.56), nor children’s intake of vegetables, fruits/berries, and sweet drinks or screen time (p > 0.05 for all). However, CHC nurses overall reported that the SSiHT material was feasible and appropriate to use in the health talks with families, and they used it in 83% of their health talks.

Although the SSiHT material was well accepted by the CHC nurses, there was no intervention effect on parental self-efficacy (primary outcome) nor health-related behaviours in children when evaluated in Swedish CHC. This warrants further research to better understand how to effectively empower parents through CHC health talks.

Registered 2 February 2022 at Clinicaltrials.gov NCT05237362; https://www.clinicaltrials.gov/study/NCT05237362.

The online version contains supplementary material available at 10.1186/s12889-025-22786-1.