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Comprehensive sexuality education is seen as a key intervention to address the high HIV-incidence rate and low knowledge among young people in South Africa, yet this lacks inclusion of learners with disabilities. At the same time, educators of learners with disabilities experience cultural barriers and lack skills and knowledge on how to deliver sexuality education in accessible formats. In response, the Breaking the Silence approach, a curriculum implementation and disability-accommodating approach, was developed and tested. This paper presents findings from a formative evaluation using in-depth interviews with educators from eight “schools for learners with special educational needs”. The paper focuses on their experience with implementing the approach. The analysis used conventional content analysis and NVIVO software. Educators conceptualized sexuality education within a risk-protection discourse. They revealed that the training and tools enabled them to provide sexuality education in accessible formats, tackle difficult topics such as sexual orientation and masturbation, and improved awareness and assertiveness within their learners. Educators identified the need for further development including a whole school approach, adjustments to differentiating developmental stages and addressing gender-specific topics. Through its application within the South African mainstream Life Orientation curriculum, this approach lends itself for further development and testing through implementing the approach within a whole school setting and ongoing support that will not only drive change in educators’ skills and knowledge but also drive the needed shift in cultural norms and values. [ABSTRACT FROM AUTHOR]

This mixed-methods paper describes the development and preliminary validation of the Behavioral Intentions Questionnaire (BIQ), a multi-scale questionnaire developed to assess determinants influencing Puerto Rican adolescents' intentions to engage in abusive behaviors in dating relationships. Items were developed qualitatively, and face and content validity were established by expert and target population judges via semi-structured interviews (n = 48), discussions, and four focus groups (n = 6 each). The questionnaire was pilot tested twice. An initial pilot test was conducted with students aged 13 to 17 from a private alternative education program in San Juan, Puerto Rico (n = 32). A second pilot test was conducted with a sample of students from the same site (n = 22), in addition to students in the same age range from a private school (n = 88) in San Juan. Confirmatory and Exploratory factor analysis was used to determine construct validity and Cronbach's coefficient alpha determined the subscales internal consistency reliability. Correlations between subscales were examined. Thematic content analysis was used to analyze qualitative data. Qualitative data suggested the need to revise or eliminate items and instructions and incorporate a social desirability measure. Factor analyses yielded a unidimensional structure for each subscale and each subscale demonstrated high internal consistency. Preliminary analysis on the factor structure, internal reliability, and validity of the BIQ were encouraging. However, further psychometric testing is needed before this measure can be considered a useful tool for measuring intentions to engage in abusive behaviors in dating relationships. [ABSTRACT FROM AUTHOR]

Background: Presbyopia is a progressive condition that reduces the eye's ability to focus on near objects with increasing age. After a systematic literature review identified no existing presbyopia-specific patient-reported outcome (PRO) instruments meeting regulatory guidance, a new PRO instrument, the Near Vision Presbyopia Task-based Questionnaire (NVPTQ), was developed. Results: To explore the patient experience with presbyopia, concept elicitation interviews were conducted with 20 presbyopic participants. The most frequently reported impacts were difficulty with reading menus/books/newspapers/magazines, reading on a cell phone/caller ID, and reading small print. Based on these results, a task-based PRO instrument (the NVPTQ) was developed instructing participants to complete four near-vision, paper-based reading tasks (book, newspaper, nutrition label, menu) under standardized settings, and subsequently assess their vision-related reading ability and associated satisfaction. The draft NVPTQ was cognitively debriefed with a sample of 20 presbyopes, which demonstrated that most participants interpreted the items as intended and endorsed the relevance of the concepts being assessed. After the qualitative research, the draft instrument was psychometrically tested using data from a Phase 2 study. Based on item-level analyses, all items in the NVPTQ demonstrated expected response option patterns and lacked substantial floor or ceiling effects. The reliability, validity, and responsiveness of the NVPTQ Performance and Satisfaction domain scores were assessed. All domains scores had large Cronbach's coefficient α values and good test–retest statistics, indicating that the scores are internally consistent and produce stable values over time. The pattern of correlations with a concurrent measure of visual functioning (National Eye Institute Visual Function Questionnaire 25) demonstrated that the NVPTQ domain scores were related to an alternative assessment of near-vision activities. The NVPTQ domain scores were able to distinguish between groups that were known to differ on the clinical outcome of uncorrected near visual acuity, supporting the construct validity of these scores. The NVPTQ domain scores showed evidence of responsiveness to change by being able to distinguish between groups defined as improved and not improved based on patient-reported and clinical outcomes. Conclusions: This research has resulted in a content-valid and psychometrically sound instrument designed to evaluate vision-related reading ability and satisfaction with vision-related reading ability. Trial registration: ClinicalTrials.gov NCT02780115. Registered 23 May 2016, https://www.clinicaltrials.gov/ct2/show/NCT02780115?term=NCT02780115&draw=2&rank=1. [ABSTRACT FROM AUTHOR]

Cyberbullying has been recognized as a serious social concern. Considering the varied contexts of online engagement by children and youth is increasingly necessary to adequately understand their experiences and the impact of their participation. An online context which requires further attention is gaming platforms, which are especially popular among boys. Methods: Using a theoretical approach of social dominance, this paper analyzed secondary data drawn from a mixed methods study of cyberbullying to investigate the prevalence and experience of gaming among a quantitative survey sample (n = 670) of 4th, 7th, and 10th grade students, as well as the experience and impact of gaming on a qualitative interview sub-sample (n = 57). Gaming prevalence rates are provided. Boys were significantly more likely to engage in internet gaming (though the effect size was small); χ² (1, n = 669) = 10.11, p = 0.001, phi = −0.123, 95% CI (−0.207, −0.047). Qualitative content analysis (QCA) identified four themes: (1) aggression (exceeding what was required to achieve game objectives) characterized gaming culture and pervaded gaming platforms; (2) anonymity contributed to the culture of aggression; (3) participants often did not consider aggression cyberbullying, but rather just a part of the culture of gaming platforms; and (4) participants' responses to aggressive behaviors. Certain behaviors on gaming platforms may not be appropriately recognized as cyberbullying. Implications for social work practice with children and youth are provided. [ABSTRACT FROM AUTHOR]

Objectives: Food insecurity (FI) has serious academic, social, and physical health consequences for children. A recent clinical recommendation suggests FI screening during child well visits. While FI screening research has considered clinician feedback, little is known about caregivers' experience of disclosing FI to health care providers. Our paper explores caregivers' barriers and facilitators to FI disclosure. Methods: A survey on factors influencing FI disclosure was completed in a pediatric clinic waiting room in St. Louis, MO. Among households with FI, 15 caregivers participated in a qualitative interview. Caregivers were asked about experiences discussing FI with health care providers. We calculated frequencies for survey responses and analyzed interview data using thematic content analysis. Results: Caregivers highlighted stigma, fear of child being taken away, and shame as barriers to FI disclosure. Caregivers identified strong interpersonal skills, open body language, and empathy as facilitators to disclosure at the interpersonal level. Provider initiated conversations, consideration of FI disclosure in the presence of a child, and normalization of FI discussions within the clinic were described as ways to encourage FI disclosure at the organizational level. In response to FI disclosure, caregivers would like providers to offer resources including referrals to community-based resources extending beyond food. Conclusions for Practice: Our study identifies considerations for FI screening in health care settings, spanning the social-ecological model, from the perspective of caregivers. To successfully screen and address FI, multifaceted health care interventions should address barriers and promote facilitators across multiple levels and in consideration of multiple social needs. [ABSTRACT FROM AUTHOR]

Purpose: Service user involvement in instrument development is increasingly recognised as important, but is often not done and seldom reported. This has adverse implications for the content validity of a measure. The aim of this paper is to identify the types of items that service users felt were important to be included or excluded from a new Recovering Quality of Life measure for people with mental health difficulties.Methods: Potential items were presented to service users in face-to-face structured individual interviews and focus groups. The items were primarily taken or adapted from current measures and covered themes identified from earlier qualitative work as being important to quality of life. Content and thematic analysis was undertaken to identify the types of items which were either important or unacceptable to service users.Results: We identified five key themes of the types of items that service users found acceptable or unacceptable; the items should be relevant and meaningful, unambiguous, easy to answer particularly when distressed, do not cause further upset, and be non-judgemental. Importantly, this was from the perspective of the service user.Conclusions: This research has underlined the importance of service users' views on the acceptability and validity of items for use in developing a new measure. Whether or not service users favoured an item was associated with their ability or intention to respond accurately and honestly to the item which will impact on the validity and sensitivity of the measure. [ABSTRACT FROM AUTHOR]

Aim: Knowledge about nurses' error perception is crucial for establishing a sustainable risk management. This paper presents categories and frequencies of errors as identified by nurses. The cross-sectional study results provide further knowledge for professional and organizational development. Subject and methods: Data from 1,100 German nurses working in 30 hospitals and 46 nursing homes were collected using a self-administered questionnaire. This paper firstly presents results from a content analysis of nurses' descriptions of errors and, secondly, results on frequencies of predefined nursing errors (closed-ended, ordinal frequency estimation). Thirdly, it compares the answers of hospital nurses with those of nurses employed in nursing homes and finally it compares answers of participant groups defined by sex or migration background. Results: In the open-ended section, errors described by 60.5 % of the participants concerned medical diagnosis/therapy. 20.7 % had experienced errors in hands-on care, while errors in communication with patients were noted by 3.7 %. In contrast, when offering predefined activities in the questionnaire's closed-ended part, indicated frequencies of errors stressed issues of hands-on care and documentation. Significant differences exist between participants from both settings regarding direct care and relationship building. Sex and migration background were related to frequency estimations. Conclusions: Findings point to shortened professional perspectives in the debates on risk and safety. This might lower nurses' compliance in risk management systems. The influence of health professionals' sex and migration background on their error perception needs further exploration. Field specific approaches for error prevention are needed. [ABSTRACT FROM AUTHOR]

This study aims to reveal the feelings, difficulties, attitudes, and spiritual coping status of Turkish patients with Type 2 diabetes mellitus toward fasting during Ramadan. The sample of this descriptive qualitative study consists of 14 patients diagnosed with Type 2 diabetes. We determined two main themes and relevant sub-themes. The first was "the feelings and difficulties experienced due to diabetes mellitus" with the sub-themes of "negative emotions" and "difficulties in fasting." The second theme was identified as "religious and spiritual coping" with the sub-themes of "believing the disease comes from God," "having difficulty in adhering to disease-specific practices while fasting," and "feeling that fasting facilitates coping and provides relief." In conclusion, it was determined that the patients continued to fast despite the difficulties and that fasting facilitated coping and provided relaxation. [ABSTRACT FROM AUTHOR]

Various studies have shown that immigrant women in comparison to non-immigrant women of the same parity have lower rates of epidural anesthesia (EDA). Data from two studies on immigrant obstetric care in Berlin, Germany were analyzed to answer the following question: What reasons do the medical staff see for the lower rate of EDA in immigrant women? Between May and August 2017, 34 interviews with obstetricians and midwives in four obstetric clinics in Berlin were conducted on the topic of obstetric care for immigrant women. After anonymizing the more than 20 h of interview material, transcripts were coded with MaxQDa and analyzed according to the qualitative content analysis.The quantitative data is from an online survey conducted between May and October 2017, in all but one obstetric clinic in Berlin with obstetricians and midwives. Regarding the research question, 121 questionnaires could be analyzed. In the online survey, (multiple answers were possible), the top reason for a lower rate of EDA given was mostly fear on the part of the immigrant women (64%). A language barrier, which results in logistic and time constrictions, is mentioned as the second most frequent reason (50%). The explorative analysis of the interviews shows that doctors and midwives regard cultural aspects such as different expectations on the birth experience as a reason for a lower EDA rate. Furthermore, within the medical staff the impression persists that in some cases the companion decides on the behalf of the patient about the application of an EDA, which from time to time is against the wish of the immigrant woman giving birth. In the view of the medical staff, the reasons for a lower rate of EDA during birth for immigrant women were varied. On one side, this is attributed to the wishes of the respective women ("demand") but on the other side this can be attributed to the health care system ("supply"). In the case of a language barrier, the "supply" and the access of EDA for immigrant women is limited and can be then shifted to the German-speaking companion to make a decision regarding EDA ("structural deprivation of self-determination"). [ABSTRACT FROM AUTHOR]

Background: Post-stroke fatigue (PSF) is commonly reported and described as disabling by patients recovering from stroke. However, a major challenge is how to accurately diagnose and assess PSF. Therefore, the aim of this study was to explore PSF as it is experienced by stroke survivors and described by health professionals to guide future development of a PSF-specific PROM. Methods: Individual semi-structured interviews were conducted with stroke survivors experiencing PSF (n = 9) and three focus groups were conducted with health professionals (n = 16). Data were analyzed through inductive content analysis. Results: The analysis revealed four themes illustrating the experience and descriptions of PSF: 1) PSF characteristics, 2) interfering and aggravating factors, 3) management, and 4) PSF awareness, which refers to stroke survivors first becoming aware of PSF after their initial hospital admission. Conclusion: This study highlights the complexity and multidimensionality of PSF. The results from this study will guide future development of a PSF-PROM and support its content validity. [ABSTRACT FROM AUTHOR]

Background: Transplantation of HIV-positive (HIV+) donor organs for HIV+ recipients (HIV D+/R+) is now being performed as research in the United States, but raises ethical concerns. While patient-reported outcome measures are increasingly used to evaluate clinical interventions, there is no published measure to aptly capture patients' experiences in the unique context of experimental HIV D+/R+ transplantation. Therefore, we developed PROMETHEUS (patient-reported measure of experimental transplants with HIV and ethics in the United States). To do so, we created a conceptual framework, drafted a pilot battery using existing and new measures related to this context, and refined it based on cognitive and pilot testing. PROMETHEUS was administered 6-months post-transplant in a clinical trial evaluating these transplants. We analyzed data from the first 20 patient-participants for reliability and validity by calculating Cronbach's alpha and reviewing item performance characteristics. Results: PROMETHEUS 1.0 consisted of 29 items with 5 putative subscales: Emotions; Trust; Decision Making; Transplant; and Decision Satisfaction. Overall, responses were positive. Cronbach's alpha was > 0.8 for all subscales except Transplant, which was 0.38. Two Transplant subscale items were removed due to poor reliability and construct validity. Conclusions: We developed PROMETHEUS to systematically capture patient-reported experiences with this novel experimental transplantation program, nested it in an actual clinical trial, and obtained preliminary data regarding its performance. [ABSTRACT FROM AUTHOR]

Background: Neurotrophic keratopathy/keratitis (NK) is a rare disease of the cornea that can lead to anatomical loss of the eye. Little is known about the NK experience from the patients' perspective. The objectives of this study were to examine the symptomatic experience and impacts of NK on patients and assess the overall comprehension, relevance, and content validity of a new questionnaire. Methods: This was a cross-sectional, qualitative study conducted with NK patients with varying levels of disease severity, recruited from one clinical site. One-on-one interviews using concept elicitation and cognitive interviewing techniques were conducted. Results: Fourteen NK patients participated; 64.3% were female (n = 9), mean age was 65.7 ± 13.3, and 14.3% (n = 2), 21.4% (n = 3), and 64.3% (n = 9) were classified as Mackie stage I, stage II, or stage III, respectively. Participants reported 24 concepts, including: redness (n = 12, 86%), sensitivity to light (n = 11, 79%), general discomfort (n = 9, 64%), dry eye (n = 9, 64%), reduced visual acuity (n = 9, 64%), blurred vision (n = 8, 57%), and eye fatigue (n = 8, 57%). No new concepts were reported after the 13th interview. The most frequently reported impacts included frustration (n = 10, 71%), driving impairment (n = 8, 57%), reading impairment (n = 7, 50%), difficulty watching television (n = 7, 50%), and concern with potentially losing their eyesight due to NK (n = 6, 43%). Participants provided positive feedback on the draft NK Questionnaire (NKQ) and felt that it was comprehensive and relevant to their experience with NK. Additionally, the recall period, instructions, item concepts, and response options were well-understood by participants. Minor revisions were made to the tool for consistency (i.e., the timeframe "in the past 7 days" was added to items 12–14); item 14 was modified to include "how often"; examples were added to item 9. Conclusions: The results of the concept elicitation portion of the qualitative study support the content validity of the draft NKQ. The clinically significant concepts identified in the literature and raised during concept elicitation are included as items in the questionnaire. Further assessment of the psychometric properties should be conducted in support of this new tool to measure the effect of new treatments on symptoms and impacts associated with NK. [ABSTRACT FROM AUTHOR]

The article discusses a study on the usefulness and usability of tools designed to assess the sexual knowledge of people with intellectual disability (ID). Topics covered include the limited sexual knowledge of people with ID serving as a barrier to sexual health, the preference by clinicians for using sexual knowledge assessment tools to support their work, and the concerns among clinicians about response bias and acquiescence associated with sexual knowledge assessment tools.

Little is known about the experience of Chinese parents of children diagnosed with autism spectrum disorders (ASD) living in the Hong Kong Special Administrative Region. Seventy-five parents of children (aged 6 months-18 years) with ASD diagnoses completed the Family Quality of Life Scale. Forty-five parents from the original surveyed cohort, also participated in semi-structured interviews. Parents' perceptions of their child's disability were influenced both by their cultural background and by the limited and expensive, pre- and post-diagnostic services available. Longer waiting times to diagnosis were associated with lower emotional well-being and perceived disability-related support. Clinicians are encouraged to become part of the support network for parents of children with ASD, to help parents to adjust to caring for their child. [ABSTRACT FROM AUTHOR]

The article examines the prevalence of sexual dysfunction and the factors that affect them in women with gynecological cancer. It mentions the role of body image, sexual role, sexual functions and reproductive health in effecting the sexual health of these women. It also mentions the use of cross-sectional and qualitative design as a study method as well as the use of index of female sexual function and in-depth interview for the collection of data.

We conducted an online survey of adult health care providers at Kaiser Permanente Northern California and semi-structured interviews with a subset of physicians. The survey assessed providers' ability to recognize autism spectrum disorder (ASD), asked them to rate their autism knowledge, comfort level in treating affected patients, and evaluated training and resource needs. 922 providers completed the survey (response rate 25.3 %), and 9 were interviewed by telephone regarding their autism training and experiences caring for patients with autism. Most providers reported lacking skills and tools to care for this adult patient population. A high proportion of adult providers were not aware that they had patients with ASD. These findings underscore the need to educate physicians caring for adults with ASD. [ABSTRACT FROM AUTHOR]

Latino immigrant men are an understudied population in the US, especially in areas with small yet growing Latino populations. For this community-based participatory health assessment we conducted four focus groups and 66 structured surveys with Latino immigrant men, and 10 openended interviews with service providers. We analyzed transcripts using content analysis and survey data using Pearson Chi-square tests. Overall, 53 % of participating men had not completed high school. Our findings suggest that their social circumstances precluded men from behaving in a way they believe would protect their health. Loneliness, fear and lack of connections prompted stress among men, who had difficulty locating healthcare services. Newly immigrated men were significantly more likely to experience depression symptoms. Latino immigrant men face social isolation resulting in negative health consequences, which are amplified by the new growth community context. Men can benefit from interventions aimed at building their social connections. [ABSTRACT FROM AUTHOR]

In Belgium, and in other OECD countries, there is a growing awareness about the importance of informal home care for the elderly's well-being. Informal care is considered as an intrinsically valuable social phenomenon. Public authorities in Belgium have been advocating an active policy of support for informal carers. In 2007, an extensive survey was carried out in the Belgian municipality of Kruibeke in order to establish a better picture of the various needs of the elderly in their home situation, but also to better understand the way in which informal care is provided and perceived by care receivers and care givers. The study points to the need for support for the difficult burden of informal care and highlights the need for a coordinated and integrated approach to elderly care. [ABSTRACT FROM AUTHOR]

The use of psychotropic medications in youth has significantly increased in recent years. Moreover, the use of multiple medications, or polypharmacy, has seen a corresponding increase. The use of medications is largely based on diagnostic impressions and the targeted symptom. However, due to the dearth of applied research with severely troubled youth, there is very little 'evidence base' to guide this practice. The Survey of Adolescent Treatment Experience study surveyed youth, currently placed in residential care, on their impressions of medication effectiveness on a wide-range of symptom categories. Youth report only mediocre effectiveness in their medication across a range of symptom questions. Approximately one third of youth indicated that they felt positive about taking medications. On average, slightly less than 50 % of youth reported benefits from medications across symptom categories. It is argued that these findings should inform the efforts toward individualized treatment models. [ABSTRACT FROM AUTHOR]

Although hyperphagia and compulsivity in Prader-Willi syndrome (PWS) are well described, recreation and adaptive skills are relatively unexplored. Parents of 123 participants with PWS (4-48 years) completed measures of their child's adaptive, recreation, and problem behaviors. Offspring received cognitive testing. Watching TV was the most frequent recreational activity, and was associated with compulsivity and skin picking. BMIs were negatively correlated with physical play, and highest in those who watched TV and played computer games. Computer games and physical activities were associated with higher IQ and adaptive scores. People with PWS and other disabilities need to watch less TV and be more engaged in physical activities, games, and leisure pursuits that are fun, and may bring cognitive or adaptive advantages. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to explore primary healthcare (PHC) professionals' experiences of the sick leave process. Methods This is an explorative study using data from four semi-structured focus group discussions with a purposeful sample of PHC professionals in Östergötland County, Sweden. Content analysis with an inductive approach was used in the analysis. Results Four key themes emerged from the analysis; priority to the sick leave process, handling sickness certifications, collaboration within PHC and with other stakeholders, and work ability assessments. Patients' need for sick leave was handled from each professional group's perspective. Collaboration was considered important, but difficult to achieve and all the competencies available at the PHC centre were not used for work ability assessments. There was insufficient knowledge of patients' work demands and contact with an employer was rare, and the strained relationship with the social insurance officers affected the collaboration. Conclusions This study highlights the challenges physicians and other PHC professionals face when handling the need for sick leave, especially when encountering patients with symptom-based diagnoses, and the influence of non-medical factors. Hindrances to good practice were increased demands, collaboration, and role responsibility. The challenges in the sick leave process concerned both content and consequences related to poor collaboration within PHC and with representatives from various organizations, primarily employers and social insurance officers. Further research on how to develop a professional approach for handling the sick leave process is needed. [ABSTRACT FROM AUTHOR]

Historically, the majority of research with American Indian (AI) youth and communities has focused on vulnerabilities, problems, and needs rather than resilience, strengths, and assets. Adding to the limited research which has examined AI youth and communities using the strengths perspective, we examined community assets, personal strengths, community challenges, and personal hardships as perceived by reservation-based, Northern Plains AI youth via open-ended survey questions. The present study was conducted during the spring and fall of 2009 at a tribal school in the Northern Plains (N = 95; n = 37 males; n = 58 females; aged 14.4-20.95 years; M = 17.3, SD = 1.47 years). The majority of youth self-identified their ethnic background as solely AI (85.3 %), with small percentages reporting additional ethnic backgrounds. Analyses revealed that the people in their lives, especially their families, are significant sources of strength for AI youth. Findings also indicated that AI youth have a positive orientation toward themselves and their communities, which was evidenced by the fact that the youth identified more strengths than challenges in their lives. Somewhat unexpectedly, when asked what aspects of their lives and communities they would most like to change, a significant number of the youth identified they wanted to change 'nothing' about their personal lives or their communities. Reasons for these responses are explored. [ABSTRACT FROM AUTHOR]

Aim: The study evaluates a community-based intervention programme, using a peer approach. The programme's objective is to improve life opportunities for children from disadvantaged families in a poor district of Berlin by empowering their mothers. Women of varying cultural backgrounds-most of them from immigrant families-are educated in subjects like child development, early education and health in order to work as community mothers (CMs). Their major task is to obtain access to the families, strengthen the mothers' parenting and personal skills, and promote early nursery school attendance and access to social support systems. Community settings are integrated in the programme through the establishment of family cafés in nursery and primary schools. Methods: The evaluation analyses the organisational structure and process determinants of the programme, and its impact on the CMs as well as on the visited family mothers (FMs), identifying the supporting and inhibiting factors. To match the comprehensive programme design, a mixed method approach was chosen, combining primarily qualitative methods with quantitative methods and participatory observation. Target groups for the investigation are the CMs, the FMs, and professionals directly or indirectly involved in the programme. Results: According to preliminary results, the programme has been successful in recruiting women from the community for training as CMs ( n = 67) and in reaching disadvantaged families of German and migrant backgrounds through home visits ( n = 86) as well as in single contacts in various settings ( n = 170). Access to families by home visits and sometimes in family cafés, however, has turned out to be more difficult than expected. The FMs interviewed qualitatively ( n = 15) within the first year after the start of home visits and with a semi-structured questionnaire ( n = 44) after 2.5 years, report increased self-esteem, improved relationships with their children, better access to public services, emotional support and practical assistance. The results also demonstrate a significant gain for the CMs themselves as part of the target group. Professionals ( n = 42) assess the project primarily positively; co-operation with the CMs sometimes presents barriers. Conclusion: Peer-based home visitation programmes are successful in reaching otherwise hard-to-reach populations but also have limits in access to some of the families. The combination of home visits with other forms of activities located in various settings seems promising. [ABSTRACT FROM AUTHOR]