Original scientific paper

Dance Gudeva Nikovska¹ , Matej Majeric² 

https://doi.org/10.46733/PESH2514109gn

Abstract

This mixed-methods study in North Macedonia explored barriers to patronage service uptake among parents and pregnant women, aiming to enhance demand and support playful learning for optimal early childhood development. Utilizing face-to-face interviews with a multistage stratified sample of 1,100 respondents (pregnant women and parents of children aged 0–5) across urban (61%) and rural (39%) areas, and six focus groups, the research examined needs, expectations, and experiences related to patronage services. The sample, stratified by region, ethnicity, and settlement type, comprised 92% female and 8% male respondents, with 55% aged 25–34 and 13% aged 18–24. Findings reveal high awareness of patronage nurses’ roles (90%), but lower knowledge among younger respondents (30%), Roma (30%), rural residents (58%), and socially disadvantaged groups (70%), particularly regarding access points and services without health insurance. Respondents primarily consult gynecologists (70%) and family (54.4%) for newborn care, with minimal reliance on social media (<3%). Qualitative data highlight trust in pediatricians (91%) and family, especially among ethnic Albanians and Roma, but note patronage nurses rarely address parental mental health, positive parenting, or playful learning (10% coverage). Systemic barriers, including low awareness, misconceptions about service coordination, and inadequate coverage during pregnancy, disproportionately affect vulnerable groups, limiting demand. These barriers hinder guidance on playful learning, critical for cognitive and socio-emotional development. Recommendations include multilingual campaigns, centralized access platforms, clarified coordination protocols, targeted outreach for vulnerable populations, and integrating playful learning education into nurse training to address time-constrained parents’ needs. Enhancing patronage services can boost uptake, reduce developmental risks, and align with Sustainable Development Goal 3, fostering equitable child development outcomes.

Key words: Patronage nurse, home visiting services, maternal and child health, playful learning, health equity, primary health care
___________________________

References

World Health Organization, United Nations Children’s Fund, World Bank Group. Nurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential. Geneva: World Health Organization; 2018. Available from https://iris.who.int/handle/10665/272603

Shonkoff, J. P., et al. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. [https://pediatrics.aappublications.org/content/129/1/e232]

National Institute of Child Health and Human Development Early Child Care Research Network (2006). Child care effect sizes for NICHD Study of Early Child Care and Youth. Development American Psychologist, 61(2), 99-116, https://doi.org/10.1037/0003-066X.61.2.99

Olds, D.L., Sadler, L., & Kitzman, H. (2007). Programs for parents of infants and toddlers. Recent evidence from randomized trials.

Journal of Child Psychology and Psychiatry, 48(3-4), 355-391. https://doi.org/10.1111/j.1469-7610.2006.01702.x

Avellar, S.A., & Supplee, L.H. (2013). Effectiveness of home visiting in improvidng maternal and child outcomes. Pediatrics, 132 (Supplement 2), S90-S99. https://doi.org/10.1542/peds.2013-1021I

Heckman, J.J. (2006). Skill formation and the economics of investing in disadvantaged children. Science, 312(5782), 1900-1902. https://doi.org/10.1126/science.1128898

Black, M.M., Walker, S.P., Fernald, L.C.H., Andersent, C.T., DiGirolamo, A.M., Lu, C., McCoy, D.C., Fink, G., Shawar, Y.R., Shiffman, J., Devercelli, A.E., Wodon, Q.T., Vargas-Baron, E., & Grantham McGregor, S. (2017). Early childhood development coming of age: Science through the life course. The Lancet, 389(10064), 77-90. https://doi.org/10.1016/S0140-6736(16)31389-7

Gratntham-McGregor, S., Cheung, Y.B., Cueto, S., Glewwe, P., Richter, L., & Strupp, B. (2007). Developmental potential in the first 5 years for children in developing countries. The Lancet, 369(9555), 60-70. https://doi.org/10.1016/S0140-6736(07)60032-4

World Bank (2018). World development report 2018. Learning to realize education promise. World Bank Group. https://www.worldbank.org/en/publication/wdr2018

United Nations Children’s Fund (2016). The state of the world’s children 2016. A fair chance for every child. UNICEF. https://www.unicef.org/reports/state-worlds-children-2016

Yogman, M., Garner, A., Hutchinson, J., Hirsh-Pasek, K., Golinkoff, R. M., & Committee on Psychosocial Aspects of Child and Family Health, & Committee on Early Childhood, Adoption and Dependent Care (2018). The power of play: A pediatric role in enhancing development in young children. Pediatrics, 142(3), e20182058. https://doi.org/10.1542/peds.2018-2058

Hirsh-Pasek, K., Golinkoff, R. M., Berk, L. E.,, & Singer, D. G. (2009). A mandate for playful learning in school: Presenting the evidence, Oxford University Press

Pyle, A., DeLuca, C., & Danniels, E. (2017). A scoping review of research on play-based pedagogies in kindergarten education. Review of Education, 5(3), 311-351. https://doi.org/10.1002/rev3.3097

Zosh, J. M., Hirsh-Pasek, K., Hopkins, E. J., Jensen, H., Liu, C., Neale, D., Solis, S. L., & Whitebread, D. (2018). Accessing the inaccessible: Redefininf play as a spectrum. Frontiers in Psychology, 9, 1124. https://doi.org/10.3389/fpsyg.2018.01124

Whitebread, D., Basilio, M., Kuvalja, M., & Verma, M. (2012). The importance of play: A report on the value of children’s play with a series of policy recommendations. https://importanceofplay.eu/LMG/pdf/dr_david_whitebread_the_importance_of_play.pdf

Milkie, M. A., Nomaguchi, K.M., & Denny, K. E. (2015). Does the amount of time mothers spend with children or adolescents matter? Journal of Marriage and Family, 77(2), 355-372. https://doi.org/10.1111/jomf.12170

Wright, C. A., Turner, D., Alessi, N., & Pyle, A. (2023). U.S. parents’ attitudes toward playful learning. Frontirs in developmental Psychology, 1, 1267169. https://doi.org/10.3389/fdpys.2023.1267169

The Global Strategy For Women’s, Children’s and Adolescents’ Health (2016-2030), available from the-global-strategy-for-women-s-children-s-and-adolescents-health-2016-2030.pdf