Transition to Parenthood: Parents’ Experiences of a Home Visiting Programme in Disadvantaged Areas of Sweden

Transition to Parenthood: Parents’ Experiences of a Home Visiting Programme in Disadvantaged Areas of Sweden | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Transition to Parenthood: Parents’ Experiences of a Home Visiting Programme in Disadvantaged Areas of Sweden Lisbeth Lindahl, Jeanette Olsson, Elin Alfredsson This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8360510/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Mar, 2026 Read the published version in International Journal for Equity in Health → Version 1 posted 7 You are reading this latest preprint version Abstract Background Early childhood represents a critical period for promoting health equity, particularly for families facing social and economic disadvantage. In Sweden, extended home visiting programmes have been introduced to strengthen early preventive support for first-time parents in disadvantaged areas. This study explored how parents experienced such a programme in Gothenburg, Sweden, with attention to trust-building, accessibility, and perceived support. Methods A qualitative design was used. Semi-structured interviews were conducted with 22 parents from 16 families who had participated in the Rinkeby Extended Home Visiting programme. Participants were strategically selected to capture variation in gender, family structure, and migration background. Interviews were analysed using reflexive thematic analysis. Results One overarching theme – Transition to parenthood – encompassed three main themes: navigating early parenthood , receiving reassurance and support in the parental role , and building trust through relationships with professionals . Parents described the early months as emotionally intense, often marked by isolation, insecure housing, or migration-related stress. Home-based visits provided reassurance, practical guidance, and emotional validation. The combination of a nurse and a parental supporter offered complementary expertise and was seen as a key strength. Trust developed through continuity, respect, and flexibility, which enabled open communication and acceptance of support. Conclusions Extended home visiting was experienced as meaningful, empowering, and accessible for families facing social disadvantage. Its relational, home-based, and interprofessional approach fostered trust and strengthened parental confidence. These findings illustrate how proportionate, equity-focused interventions can support parents and promote healthy early child development in diverse urban settings. child health services early child development extended home visiting health equity interprofessional collaboration migration parental support prevention qualitative research transition to parenthood Introduction Sweden is known for its universal welfare system and robust public health infrastructure [ 1 ]. This includes the national child health programme, which offers regular health check-ups, developmental screening, and parental support through Child Health Care (CHC) centres. Nevertheless, despite overall improvements in population health, the country continues to face persistent social and health inequalities. Children growing up in families affected by poverty, insecure housing, or limited social networks are at greater risk of poorer health, developmental challenges, and reduced access to welfare services [ 1 , 2 ]. These disparities are particularly pronounced in urban areas characterised by residential segregation and a high proportion of newly arrived migrant families​. Migration intersects with social inequality in multiple ways. Families who have recently arrived in Sweden often face not only material hardship but also cultural dislocation, limited knowledge of the welfare system, and lack of social support. For these parents, the transition to parenthood can be understood as a “double transition”: adapting to a new life role while simultaneously navigating life in a new country [ 3 , 4 ]. The early years of life represent a critical period for supporting families and promoting long-term health equity. Home-visiting interventions have shown promising effects internationally, particularly when embedded in relationship-based, culturally responsive, and preventive care models [ 5 , 6 ]. In Sweden, the Rinkeby Extended Home Visiting (REHV) programme exemplifies such an approach. It complements the ordinary CHC programme by offering additional support through structured home visits to all first-time parents living in specific, socioeconomically disadvantaged areas. The programme comprises six home visits during the child’s first 15 months, delivered by a team consisting of a CHC nurse and a social worker from preventive social services [ 7 ]. The model is grounded in the principle of proportionate universalism [ 8 ]: it offers universal services in selected areas, with the intensity and form of support adjusted to the general needs of the local population. In 2018, the City of Gothenburg implemented the model in selected areas and broadened eligibility to include parents who already had children but were having their first child in Sweden, recognising that previous parenting experience may not be fully transferable across cultural and systemic contexts. In this local adaptation, social workers were referred to as parental supporters rather than parental advisors, as in the Rinkeby project [ 9 ]. The target population is thus diverse, including single parents, recently arrived migrants, asylum seekers, and families with limited access to resources and networks. While previous studies have reported positive outcomes associated with the REHV model —such as improved vaccination coverage, increased trust in health services, and strengthened parental self-efficacy [ 10 , 11 ] — research on how families themselves experience these types of programmes remains limited, particularly among those facing multiple forms of disadvantage. To date, only a few qualitative studies have explored parents’ perspectives. Bäckström and colleagues [ 12 ] identified how the physical environment, feelings of self-confidence, and parental participation shaped parents’ experiences of home visits in the Reinforced Parenting – Extended Home Visits programme, while Sjögren Forss and colleagues [ 13 ] examined parents’ early impressions after the first home visit in the Growing Safely programme, highlighting trust in professionals and a sense of safety. More recently, a study of the Together for a Safe Start programme—an extended version of the Rinkeby model tested in four middle-sized Swedish municipalities—found that trust, information on child development, and socioemotional support were key components of a successful home visiting [ 14 ]. Although these studies provide valuable insights, they are based on modified versions of the REHV programme, which limits their applicability to the fully implemented model used in Gothenburg and now being scaled up across Region Västra Götaland. This version adheres closely to the original Rinkeby model, with only minor adjustments in terminology and inclusion criteria. There is therefore a need for research that captures parental experiences of the programme in its full form and in urban settings. Understanding parents’ perspectives is essential for designing services that are responsive, equitable, and effective in reaching those who need them most. The present study thus aimed to explore how parents living in socioeconomically disadvantaged areas of Gothenburg experienced the original version of the Rinkeby Extended Home Visiting (REHV) programme. Particular attention was paid to how families with varied migration backgrounds and social conditions perceived the support, and to themes associated with the programme’s perceived value. Method Study design and setting This study formed part of a larger mixed-methods evaluation of the REHV programme in Gothenburg, and an earlier, preliminary version of the findings is presented in a final report covering the larger research project [15]. We employed a qualitative design based on semi-structured interviews with parents who had participated in the programme (see appendix 1 for the interview guide). All participating parents lived in areas classified as socioeconomically disadvantaged. Interviews were conducted between 2020 and 2022 as part of the programme’s formal evaluation. The study was grounded in a social constructivist epistemology [16], which views knowledge and meaning as co-constructed through social interaction and shaped by cultural and contextual factors. This orientation informed our use of reflexive thematic analysis [17], highlighting both participants’ situated experiences and the researchers’ active role in interpretation. Programme description In Gothenburg, the REHV programme is delivered in selected socioeconomically disadvantaged areas through collaboration between CHC services and preventive social services. Between 2018 and 2023, six areas implemented the programme. Parents of a first-born child, or their first child born in Sweden, are invited to participate when their children are between 0 and 15 months old, with both caregivers encouraged to take part. The programme consists of six one-hour visits, which are integrated with the standard CHC visits. Each visit is conducted jointly by a CHC nurse and a parental supporter (a trained social worker), both typically experienced professionals who bring complementary expertise. The nurse focuses on child health, growth, feeding, sleep, safety, and developmental guidance, while the parental supporter addresses psychosocial support, parenting and couple dynamics, and navigation of welfare services. A key feature of the programme is that professionals remain receptive to the parents’ questions, working actively to strengthen parental confidence. The two professionals are regarded essential resources in delivering the visits, and their collaborative approach in the family’s home forms the central pillar of the intervention. Having two professions allows the programme to cover a broad range of topics and respond to diverse family needs, while also providing multiple perspectives on early childhood development and parenting. Working consistently with the same partner enables the professionals to build a supportive dynamic, which is particularly valuable in complex or challenging situations [18]. For families with additional needs, support can be extended beyond the six visits or offered through referrals to other services. Interpreters are available when required. Recruitment and participants Parents were recruited by CHC nurses and parental supporters involved in the programme, who were asked to identify participants for a strategic sample. The sampling aimed to ensure variation in gender, family type (single parents and couples), and parental experience, including both first-time parents and those having their first child in Sweden. Each participating CHC centre was asked to contribute with a number of families proportional to its size. Parents were approached during the fifth or sixth home visit and informed about the study. The intention was to interview parents who had completed all six visits; however, exceptions were made for practical reasons (e.g., imminent relocation), and in a few cases, parents had completed only four or five visits. Sixteen families participated in the study. Most were first-time parents ( n = 12) while others participated with their second ( n = 3) or fourth child ( n = 1). In total, 22 parents were interviewed, since some interviews included both parents (14 mothers and 8 fathers). Most participants had migrated to Sweden ( n = 14). In eight families, one or both parents had lived in Sweden for less than three years. Two families were asylum seekers. Three families had parental migration background, while five participants had no familial migration history. Most families consisted of married or cohabiting parents ( n = 14), while two were single mothers. There was a predominance of girls ( n = 10) over boys ( n = 6) within the participating families. Housing conditions varied: some families lived in rental apartments ( n = 9), others owned their homes (n = 5), while a few lacked permanent housing ( n = 2). Data collection Interviews were conducted when the child who had received the intervention was around 15 months old, although in some cases they took place later due to delays caused by the Covid-19 pandemic. In some instances, home visits had also been relocated to CHC centres or rescheduled in line with infection-control measures. The interviews were carried out by the first author as conversations with open-ended questions which allowed the participants to talk freely about their experiences. A semi-structured interview guide was used to ensure that key topics were covered (see Appendix 1). The guide addressed areas such as parents’ experiences of the home visits, their perceptions of contact with professionals, the support provided, and how the programme related to their needs and circumstances. Most interviews were conducted in participants’ homes ( n = 13), while three were conducted by phone due to Covid-related restrictions or lack of stable housing. Interviews lasted approximately 60–90 minutes and were carried out in Swedish or English, sometimes with the support of authorized interpreters ( n = 4). When both parents participated, or when an interpreter was present, interviews tended to be longer. Interpretations were made in Arabic, Persian, and Somali. All but one interview were audio-recorded and transcribed verbatim, with participation in recording being voluntary. In the single case where recording was declined, the interviewer took detailed notes instead. Analysis The interviews were analysed using reflexive thematic analysis [17,19]. The approach was primarily inductive but informed by sensitising concepts – such as trust, support, and transitions related to parenting and migration. The authors independently read and familiarised themselves with the material, generating initial codes. Through an iterative process, codes were compared, discussed, and refined into candidate themes and subthemes. Following Braun and Clarke’s six phases, the transcripts were: (1) familiarised with, (2) coded, (3) searched for themes, (4) reviewed, (5) defined and named, and (6) reported. Coding focused on segments pertinent to parents’ experiences of the intervention. Themes were actively conceptualized, with transcripts and codes revisited multiple times until final definitions were established. Attention was paid both to cross-participant patterns and to variation associated with family structure, migration background, and perceived needs. The interviews reported here are the same dataset as in the earlier project report [15], but the analysis has since been revisited and further developed. Specifically, we refined the thematic structure by repeating phases 4–6 (reviewing, defining/naming, and reporting themes) in Braun and Clarke’s framework. Ethical considerations Ethical approval was obtained from the Swedish Ethical Review Authority (Etikprövningsmyndigheten), decision number Dnr 2019–05839, and the study adhered to national guidelines and applicable regulations for research involving human participants. Participants received written and oral information about the study in their preferred language and provided informed consent prior to participation. Confidentiality was safeguarded through anonymisation and secure data handling; no identifying information is presented in the published material. Researcher reflexivity The research team comprised psychologists and a social worker with clinical experience in child and family services and migration-related issues. Reflexivity was integrated throughout the process, particularly in interpreting interview data from families with diverse cultural and linguistic backgrounds. Efforts were made to minimise power dynamics during interviews, including when interpreters were present. In line with reflexivity [20], we acknowledge that our backgrounds and perspectives – such as generational and parental statuses (parent/grandparent) and professional experience supporting children, young people, and parents – shaped coding decisions and theme development, and enriched analytic discussions. Results The aim of this study was to explore parents’ experiences of the REHV programme in socioeconomically disadvantaged areas of Gothenburg. The qualitative analysis generated one overarching theme – Transition to parenthood – which encompassed three main themes: navigating early parenthood , receiving support and reassurance in the parental role , and building trust through relationships with professionals (see Table 1 ). These themes are further elaborated in eight subthemes and illustrated in the text with selected quotations. Table 1 Themes describing parents’ experiences of the extended home visiting programme . Overarching theme Main theme Subtheme Transition to parenthood Navigating early parenthood Living conditions Social networks Cultural shift Receiving reassurance and support in the parental role Home-based support Reassurance and guidance Building trust through relationships with professionals Trust in the staff Individualised and adaptable support Complementary expertise The table summarises the overarching theme, main themes, and subthemes derived from the reflexive thematic analysis of interviews with parents participating in the extended home visiting programme. Navigating early parenthood Becoming a parent was often described as a profound process of adaptation – a transition that, for some, was compounded by a “double transition”: adjusting to parenthood while simultaneously adapting to a new society. Parents spoke of trying to find their footing in this unfamiliar situation and to attune themselves to the needs of their baby. Various external circumstances were experienced as barriers to this process. While some families lived in relatively stable conditions and had access to supportive networks, others described considerable vulnerability related to migration, housing insecurity, social isolation, and limited familiarity with Swedish society and culture. These contextual factors shaped how the REHV programme was perceived and received. Living conditions varied considerably across participants, including differences in migration background, employment status, and family structure (e.g. cohabiting couples versus single parents). Parents who were asylum seekers described themselves as particularly vulnerable, as their daily lives were marked by uncertainty about their right to stay in Sweden. Another significant factor was whether the family had access to secure housing and financial stability. “The lack of housing and not to be able to get help from the unemployment security, or the employment agency is hard.“ (first-time mother without own migration history) Moreover, many families lived in neighbourhoods where they did not feel safe due to crime and violence, expressing that they did not want to raise their children in the area. “There are a lot of problems in this neighbourhood. Every evening the police are here, and ambulances, and cars are set on fire. And there are a lot of gangs running around in the area (…) I don’t want my children to grow up in this neighbourhood.” (father with two children and migration history) For parents with little or no social networks , feelings of isolation and emotional vulnerability were common, particularly during the first months with a newborn. Parents described being far from their extended families and experiencing difficulties in forming new relationships. As one parent who had moved to a new city without family or friends expressed: “Above all, it’s different because we’re new to this community […] it felt a bit scary to stand there alone with my child and have my parents so far away.” (first-time mother without own migration history) Sometimes, the language barrier intensified feelings of loneliness, even when parents were able to visit places where they could meet others: “When I go to the open preschool, I see many other women there, and they speak Swedish, but I cannot speak Swedish. I don’t understand what they are saying… so it is so difficult for me to… communicate… I can’t go anywhere… I’m just visiting and sitting and watching, so it is not fun for me.” (mother of two children with migration history) The cultural shift in parenting expectations was also a recurring theme. Parents contrasted their experiences in Sweden with traditions in their countries of origin, where parenting was typically embedded within extended family structures and responsibilities were shared among relatives. For parents who had previously raised children outside Sweden, the situation in the new country was described as so different that they felt like becoming a first-time parent again: “It’s like I am starting all over again. […] I must do everything now; there is no one I can turn to. I must do everything myself. […] My home country and Sweden are different. When you give birth there, all the family is close. You get a lot of help – you could sleep a few hours, and my mother or grandmother or some relative was at home taking care of the children and helping out. It is different (…) People there are there to help you, because in XX [the country] when a mother has a baby, people come and… bathe you, massage you, and you don’t have to do anything or go anywhere (…) they bring you food. All you do is eat and breastfeed the baby. You do that for three months before you even start going out again.” (mother of two children with migration history) In sum, parents described how their living conditions, limited social networks, and the cultural shift involved in raising a child in a new society shaped their emotional state, expectations, and support needs. These intertwined challenges made the presence of consistent and supportive professionals particularly meaningful. Receiving reassurance and support in the parental role The fact that the professionals came to the families’ homes was described as fostering more equal and open relationships with the professionals. Parents consistently emphasized the value of receiving home-based support , particularly during the emotionally intense early stages of parenthood. The home environment was described as psychologically reassuring, less stressful than clinic-based visits, and more conducive to open conversation. “They come home and they know about children, and I feel there’s something familiar about them coming home – it’s a psychological thing. I can feel so safe.” (first-time mother without migration history) Being at home made it easier to discuss practical matters, such as feeding and sleeping arrangements, by allowing parents to demonstrate these routines directly in their everyday environment. Moreover, being at home made it easier for the child to display its natural behaviour compared to in the unfamiliar environment of the CHC centre, which further enriched the guidance they received. Parents also emphasised that they valued the reassurance and guidance provided by the staff. This reassurance was described as particularly important for those who lacked strong support networks or felt uncertain in their new role. Being met without judgement and having their efforts acknowledged had a strong emotional impact: “The biggest gain for me has been that I am enough […] The best part was not having to compare myself to others.” (first-time mother without migration history) The professionals provided concrete guidance, both in relation to child development and the parents’ own wellbeing. Fathers, in particular, emphasized that they had learned how to engage more actively in infant care and to share responsibilities with their partners: “We got very good guidance […]. Raising a child isn’t easy – you must cooperate and share the responsibility.” (first-time father with two children and migration history) Parents appreciated receiving knowledge from the staff about their child’s needs, tailored to each child’s developmental stage. The information encompassed a wide range of topics, including nutrition, sleep, ways to stimulate development, and child safety. “Actually, it was informative, because, well, you could get this sufficient information. They mentioned that if the child is not walking, how to support it...They also mentioned teaching the child what things are called. NN (the nurse), she provided most of the information about the child's development, what happened during these periods...and she gave me some insight because, you know, I don't have a lot of knowledge since I was – I am so young.“ (young first-time single mother without own migration history) In sum, parents highlighted that receiving reassurance and guidance in the parental role – delivered in their own homes - combined emotional validation, practical advice, and culturally responsive information in a way that strengthened their confidence and reduced uncertainty. The home-based format was experienced as especially valuable for those facing isolation, unfamiliarity with Swedish systems, or limited access to other sources of support. Building trust through relationships with professionals Most parents experienced that they had developed trustful relationships with the professionals, grounded in continuity, flexibility, and complementary roles. Parents emphasized that such trust was a prerequisite for accepting support from professionals. Continuity of staff – that they consistently met the same individuals over time – was regarded as a key element in building trust in the staff . Trust was also linked to feelings of being listened to and validated as a parent, as well as to receiving reliable knowledge about the child’s needs. Several parents emphasized that trust in the staff was necessary to enable them to address sensitive issues. Trust was associated with feeling safe, which required both time and stability in the relationship. “It’s absolutely crucial (…) opening up is hard […] if new people kept coming, you wouldn’t feel like opening up.” (first-time mother without migration history) The threshold for contacting the staff was described as low, which in turn fostered a sense of safety in the relationship: “They tell us, you must not wait until the next visit. Whatever happens, small or big things, you can call us (…) We feel that there is always support behind us, always someone there. If my parents aren’t here and her parents are not here, we felt that there was always someone holding us and supporting us.” (first-time father with migration history) Another aspect of creating trustworthy relationships concerned the flexibility of the programme. Most parents experienced that they had received individualised and adaptable support according to their own needs – for example, that the staff adapted the content of the home visits to the parents’ questions and concerns, and that appointments could be scheduled at times when the fathers were able to participate. For families with additional needs, support was also extended beyond the regular visits, as the programme allowed for additional meetings. These extra sessions could include guidance on breastfeeding, and assistance in contacting welfare authorities (for example, for help with financial difficulties, housing challenges, or psychological wellbeing). In some cases, the staff arranged separate meetings to ensure enough time to discuss these issues in dept and to offer support based on their own expertise. In other cases, they helped the parent to get in contact with other professionals or organisations that could provide further assistance. The parental supporters provided information about parents’ rights within the welfare system and could also accompany parents to community activities where they could meet other parents, thereby helping to reduce social isolation. “She, the parental supporter... I actually called her several times. (…) with the child benefit, she helped me several times – she even called the Social Insurance Agency…. She also helped with the maintenance allowance.” (first-time single mother without migration history) Parents emphasized that the two professionals – the CHC nurse and the parental supporter – contributed complementary expertise . The nurse primarily focused on child health and development, while the parental supporter addressed broader concerns such as the couple relationship, psychosocial support, and guidance on available social services. This dual approach was perceived as one of the programme’s distinctive strengths. “It was good with both because they complemented each other […] They had different areas of expertise.” (first-time father with migration history). Altogether, the continuity and dependability of the staff, the flexible and individualised support, and the complementary expertise of the two professionals formed the basis for trustful relationships in which parents felt able to address difficult questions, show vulnerability, and strengthen their confidence in the wider welfare system. Discussion The Rinkeby Extended Home Visiting (REHV) programme offers structured home visits by a child health care (CHC) nurse and a parental supporter from preventive social services. In Gothenburg, the model was adapted to include both first-time parents and those having their first child in Sweden, acknowledging that previous parenting experience may not always transfer across cultural and systemic contexts. This study explores parents’ own perspectives through in-depth interviews, providing deeper insights into how parents living in disadvantaged areas perceived and valued the programme. An overarching theme emerged in the results: the transition to parenthood, connected with the subthemes navigating early parenthood, receiving reassurance and support in the parental role, and building trust through relationships with professionals. Together, these findings shed light on the relational and contextual processes through which extended home visiting can promote equity in early childhood development. Parents described diverse and sometimes precarious circumstances: some had stable living conditions and strong social networks, while others faced insecure housing, social isolation, and migration-related stress. For families with migration backgrounds, the transition to parenthood in Sweden involved a “double transition”— adapting to both a new life stage and an unfamiliar society. These parents needed to relate to a cultural shift. Many contrasted the individualised Swedish model of parenthood with practices in their countries of origin, where extended family networks typically shared childcare responsibilities. Such accounts echo earlier findings from the Rinkeby model, highlighting how structural disadvantage and cultural dislocation shape parents’ experiences of support [ 7 , 11 ]. Swedish-born parents did not describe the same cultural shift, but reported challenges linked to poverty, neighborhood insecurity, and weak social networks. This aligns with research showing persistent health inequalities among children living in socioeconomically disadvantaged areas and the need for proportionate universalism [ 1 , 2 , 21 ]. Parents emphasised that receiving support at home was reassuring and lowered the threshold for engagement. The home environment enabled parents to relax more than in the clinic-based setting, making it easier to feel safe and to open up about sensitive issues. This is in line with earlier research showing that home visits can foster trust and openness in sensitive conversations [ 12 , 13 ]. Being at home also allowed the professionals to observe the child in everyday routines and to tailor guidance accordingly, which made the support more concrete and practical. The combination of emotional validation, practical advice, and culturally responsive information helped parents gain confidence and reduced feelings of isolation. Beyond reassurance, parents described that being told they were doing well gave them a sense of pride and empowerment in their new role, resonating with earlier Swedish studies [ 12 , 13 ]. These findings also align with Al-Adhami and colleagues [ 14 ], who found that home-based visits provided both emotional reassurance and informational support, enabling parents to build confidence and trust in professionals. Their study underscores how tailored, relationship-centred home visiting can reduce parental stress and increase accessibility for families with diverse backgrounds. Taken together, these findings resonate with international research showing that home-based, relationship-focused interventions can strengthen parental confidence and improve access to services [ 5 , 6 , 22 ]. Parents consistently described trust as a prerequisite for accepting professional support. Continuity of staff, non-judgmental attitudes, and the low threshold for contact between visits were central to this trust. Parents valued the dual-professional model: nurses provided health and developmental expertise, while parental supporters offered psychosocial guidance and help navigating welfare systems. This complementarity was perceived as particularly important for families facing multiple disadvantages. The importance of trust and relational continuity is also reinforced by Al-Adhami and colleagues [ 14 ], who highlight how ongoing relationships and accessibility are essential for fostering parents’ sense of security and willingness to seek help. The findings align with the Nurturing Care Framework [ 23 ] which emphasises integrated health, caregiving, and social support, and with evidence that interprofessional collaboration enhances equity in early years services [ 18 , 21 , 24 ] (Barboza et al., 2022; Franzén & Nilsson, 2024; Golsäter & Andersson, 2024). Strengths and limitations A key strength of this study is its emphasis on parents’ own voices, providing an in-depth perspective on the REHV programme that has not previously been documented. The depth of the analysis was supported by the interviewer’s responsiveness to the parents’ narratives and by the fact that almost all interviews were conducted in the families’ homes. The sample was strategically varied in terms of residential area, gender, family structure, and migration background, which enhanced the diversity of perspectives. Limitations include that some interviews were conducted with interpreters, which may have led to loss of nuance despite the use of authorised professionals. Finally, as a single-city study, transferability may be limited; however, the findings offer analytic insights that may be relevant to other urban contexts characterised by segregation and inequality. Implications and conclusion The findings suggest that extended home visiting programmes—when designed with attention to equity, cultural sensitivity, and relational continuity—can play a key role in supporting families living in socioeconomically disadvantaged areas, enhancing their capacity to give children a strong start in life. These programmes are particularly pertinent in urban settings characterised by segregation and structural barriers to health and social services. Consistent with Al-Adhami and colleagues [ 14 ], the results highlight the potential of home-based, trust-oriented interventions to strengthen parental confidence, reduce social isolation, and facilitate connections to services. By prioritising trust, accessibility, and the dual transitions of parenting and migration, the REHV programme was experienced as both practical and empowering. These insights underscore the promise of proportionate, relationship-based models in promoting equity and supporting optimal early childhood development. Abbreviations CHC Child Health Care REHV Rinkeby Extended Home Visiting Declarations Ethics approval and consent to participate Ethical approval was obtained from the Swedish Ethical Review Authority (Dnr 2019–05839). All participants provided oral and written informed consent. Consent for publication All participants provided informed consent for the publication of the analyzed and thematised interview data. Only anonymized excerpts are included, and no identifying information is presented in the published material. Availability of data and materials In accordance with Swedish legislation regulating research involving human participants, and to safeguard the confidentiality and integrity of the individuals who participated in the study, the interview transcripts that constitute the primary data cannot be made publicly available. Nonetheless, illustrative excerpts from the material have been incorporated into the manuscript where appropriate. Competing interests The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding Economic support for this research was provided by Gothenburg City and Region Västra Götaland. Authors' contributions Conceptualization: LL, EA; methodology: LL, EA; formal analysis: LL, EA; visualization: LL, EA; investigation: LL; writing – original draft preparation: LL, JO; writing – review and editing, LL, JO, EA; project administration, LL. All authors read and approved the final manuscript. Note. LL = Lisbeth Lindahl, EA = Elin Alfredsson, JO = Jeanette Olsson. Acknowledgements We gratefully acknowledge all participating parents, the interpreters who assisted during the interviews, and the professionals in the REHV programme in Gothenburg who supported the recruitment of informants for the study. Special thanks also to Louise Bäckemo Johansson for her valuable contributions. References Socialdepartementet. Nästa steg på vägen mot en mer jämlik hälsa – Förslag för ett långsiktigt arbete för en god och jämlik hälsa. SOU 2017:47. Stockholm: Statens Offentliga Utredningar; 2017. Wallby T, Hjern A. Child health care uptake among low-income and immigrant families in a Swedish county. Acta Paediatr. 2011;100(11):1495–503. Barboza M. Utvärdering av utökade hembesök: Långsiktiga effekter i Rinkeby. Stockholm: Karolinska Institutet; 2022. Degni F, Suominen S, Essén B, El Ansari W, Vehviläinen-Julkunen K. Communication and cultural issues in providing reproductive health care to immigrant women: Health care providers’ experiences in meeting Somali women living in Finland. J Immigr Minor Health. 2006;8(2):113–23. Olds DL, Kitzman H, Cole R, Hanks C, Arcoleo K, Anson E, et al. Effects of nurse home visiting on maternal and child functioning: Age-nine follow-up of a randomized trial. Pediatrics. 2007;120(4):e832–45. Peacock S, Konrad S, Watson E, Nickel D, Muhajarine N. Effectiveness of home visiting programs on child outcomes: A systematic review. BMC Public Health. 2013;13:17. Marttila A, Johansson M, Burström B, Kulane A. Implementation of extended home visits in a disadvantaged area in Stockholm, Sweden: Parental and professional perspectives. Prim Health Care Res Dev. 2017;18(4):365–75. Marmot M. Fair society, healthy lives: The Marmot Review. Strategic review of health inequalities in England post-2010. London: The Marmot Review; 2010. Lindahl L, Alfredsson E. Att finna sin roll, att så ett frö – föräldrastödjarnas arbete i barnhälsovården. Göteborg: Göteborgsregionen, FoU i Väst; 2022. Barboza M, Burström B, Marttila A. A health promotion programme for parents and children in a disadvantaged area in Sweden: A qualitative study of the participants’ experience. Health Soc Care Community. 2021;29(5):1457–65. Burström B, Marttila A, Kulane A, Barboza M. Extended home visits to new parents in Rinkeby, Sweden: A qualitative study of health visitor and parental perspectives. Scand J Public Health. 2020;48(5):534–41. Bäckström C, Barboza M, Thorstensson S. Parents’ experiences of receiving professional support through extended home visits during the child’s first 15 months: A phenomenographic study. Scand J Caring Sci. 2021;35(2):437–45. Sjögren Forss K, Mangrio E, Persson K. First-time parents’ experiences of a combined home visit by a midwife and child health care nurse within the Swedish Child Health Care: A qualitative study. BMC Health Serv Res. 2022;22(1):257. Al-Adhami M, Kornaros KG, Lönnberg G. Supported in a time of need – First-time parents’ perceptions of a Swedish extended home visiting program. BMC Prim Care. 2025;26(1):281. Lindahl L, Alfredsson A, Petrini E, Bäckemo Johansson L. Betydelser och effekter av utökade hembesök i Göteborg. Göteborg: FoU i Väst; 2023. Berger PL, Luckmann T. The social construction of reality : a treatise in the sociology of knowledge. 1st ed. New York: Anchor Books; 1967. 288 p. Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019 Aug 8;11(4):589-97. Barboza M, Marttila A, Burström B, Kulane A. Towards health equity: core components of an extended home visiting intervention in disadvantaged areas of Sweden. BMC Public Health. 2022;22:1091. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. Elliott R, Fischer CT, Rennie DL. Evolving guidelines for publication of qualitative research studies in psychology and related fields. Br J Clin Psychol. 1999;38(3):215–29. Golsäter M, Andersson A-C. Collaborative extended home-visits as a key to facilitating early support within the frame of a family centre in Sweden. BMC Health Serv Res. 2024;24:1532. McDonald M, Moore TG, Goldfeld S. Sustained nurse home visiting for families and children: A review of effective programs. Melbourne: Murdoch Children’s Research Institute; 2019. World Health Organization. Nurturing care for early childhood development: A framework for helping children survive and thrive to transform health and human potential. Geneva: WHO; 2018. Franzén K, Nilsson S. Supporting first-time parents in their homes: Boundary work in interprofessional collaboration within an extended home visiting programme. Front Public Health. 2024;12:1389910. Additional Declarations No competing interests reported. Supplementary Files Appendix1IJEH.docx Cite Share Download PDF Status: Published Journal Publication published 21 Mar, 2026 Read the published version in International Journal for Equity in Health → Version 1 posted Editorial decision: Revision requested 26 Jan, 2026 Reviews received at journal 26 Jan, 2026 Reviewers agreed at journal 16 Jan, 2026 Reviewers invited by journal 12 Jan, 2026 Editor assigned by journal 24 Dec, 2025 Submission checks completed at journal 24 Dec, 2025 First submitted to journal 23 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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07:12:05","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":19536,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1IJEH.docx","url":"https://assets-eu.researchsquare.com/files/rs-8360510/v1/b1e8fa814cc0bab6fbc16217.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Transition to Parenthood: Parents’ Experiences of a Home Visiting Programme in Disadvantaged Areas of Sweden","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSweden is known for its universal welfare system and robust public health infrastructure [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This includes the national child health programme, which offers regular health check-ups, developmental screening, and parental support through Child Health Care (CHC) centres. Nevertheless, despite overall improvements in population health, the country continues to face persistent social and health inequalities. Children growing up in families affected by poverty, insecure housing, or limited social networks are at greater risk of poorer health, developmental challenges, and reduced access to welfare services [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These disparities are particularly pronounced in urban areas characterised by residential segregation and a high proportion of newly arrived migrant families​.\u003c/p\u003e \u003cp\u003eMigration intersects with social inequality in multiple ways. Families who have recently arrived in Sweden often face not only material hardship but also cultural dislocation, limited knowledge of the welfare system, and lack of social support. For these parents, the transition to parenthood can be understood as a \u0026ldquo;double transition\u0026rdquo;: adapting to a new life role while simultaneously navigating life in a new country [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe early years of life represent a critical period for supporting families and promoting long-term health equity. Home-visiting interventions have shown promising effects internationally, particularly when embedded in relationship-based, culturally responsive, and preventive care models [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In Sweden, the Rinkeby Extended Home Visiting (REHV) programme exemplifies such an approach. It complements the ordinary CHC programme by offering additional support through structured home visits to all first-time parents living in specific, socioeconomically disadvantaged areas. The programme comprises six home visits during the child\u0026rsquo;s first 15 months, delivered by a team consisting of a CHC nurse and a social worker from preventive social services [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The model is grounded in the principle of \u003cem\u003eproportionate universalism\u003c/em\u003e [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]: it offers universal services in selected areas, with the intensity and form of support adjusted to the general needs of the local population.\u003c/p\u003e \u003cp\u003e In 2018, the City of Gothenburg implemented the model in selected areas and broadened eligibility to include parents who already had children but were having their first child in Sweden, recognising that previous parenting experience may not be fully transferable across cultural and systemic contexts. In this local adaptation, social workers were referred to as \u003cem\u003eparental supporters\u003c/em\u003e rather than parental advisors, as in the Rinkeby project [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The target population is thus diverse, including single parents, recently arrived migrants, asylum seekers, and families with limited access to resources and networks.\u003c/p\u003e \u003cp\u003eWhile previous studies have reported positive outcomes associated with the REHV model \u0026mdash;such as improved vaccination coverage, increased trust in health services, and strengthened parental self-efficacy [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] \u0026mdash; research on how families themselves experience these types of programmes remains limited, particularly among those facing multiple forms of disadvantage. To date, only a few qualitative studies have explored parents\u0026rsquo; perspectives. B\u0026auml;ckstr\u0026ouml;m and colleagues [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] identified how the physical environment, feelings of self-confidence, and parental participation shaped parents\u0026rsquo; experiences of home visits in the \u003cem\u003eReinforced Parenting \u0026ndash; Extended Home Visits\u003c/em\u003e programme, while Sj\u0026ouml;gren Forss and colleagues [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] examined parents\u0026rsquo; early impressions after the first home visit in the \u003cem\u003eGrowing Safely\u003c/em\u003e programme, highlighting trust in professionals and a sense of safety. More recently, a study of the \u003cem\u003eTogether for a Safe Start\u003c/em\u003e programme\u0026mdash;an extended version of the Rinkeby model tested in four middle-sized Swedish municipalities\u0026mdash;found that trust, information on child development, and socioemotional support were key components of a successful home visiting [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough these studies provide valuable insights, they are based on modified versions of the REHV programme, which limits their applicability to the fully implemented model used in Gothenburg and now being scaled up across Region V\u0026auml;stra G\u0026ouml;taland. This version adheres closely to the original Rinkeby model, with only minor adjustments in terminology and inclusion criteria. There is therefore a need for research that captures parental experiences of the programme in its full form and in urban settings. Understanding parents\u0026rsquo; perspectives is essential for designing services that are responsive, equitable, and effective in reaching those who need them most.\u003c/p\u003e \u003cp\u003eThe present study thus aimed to explore how parents living in socioeconomically disadvantaged areas of Gothenburg experienced the original version of the Rinkeby Extended Home Visiting (REHV) programme. Particular attention was paid to how families with varied migration backgrounds and social conditions perceived the support, and to themes associated with the programme\u0026rsquo;s perceived value.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cstrong\u003eStudy design and setting\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study formed part of a larger mixed-methods evaluation of the REHV programme in Gothenburg, and an earlier, preliminary version of the findings is presented in a final report covering the larger research project\u0026nbsp;[15]. We employed a qualitative design based on semi-structured interviews with parents who had participated in the programme (see appendix 1 for the interview guide). All participating parents lived in areas classified as socioeconomically disadvantaged. Interviews were conducted between 2020 and 2022 as part of the programme’s formal evaluation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study was grounded in a social constructivist epistemology\u0026nbsp;[16], which views knowledge and meaning as co-constructed through social interaction and shaped by cultural and contextual factors. This orientation informed our use of reflexive thematic analysis\u0026nbsp;[17], highlighting both participants’ situated experiences and the researchers’ active role in interpretation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProgramme description\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Gothenburg, the REHV programme is delivered in selected socioeconomically disadvantaged areas through collaboration between CHC services and preventive social services. Between 2018 and 2023, six areas implemented the programme. Parents of a first-born child, or their first child born in Sweden, are invited to participate when their children are between 0 and 15 months old, with both caregivers encouraged to take part.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe programme consists of six one-hour visits, which are integrated with the standard CHC visits. Each visit is conducted jointly by a CHC nurse and a parental supporter (a trained social worker), both typically experienced professionals who bring complementary expertise. The nurse focuses on child health, growth, feeding, sleep, safety, and developmental guidance, while the parental supporter addresses psychosocial support, parenting and couple dynamics, and navigation of welfare services. A key feature of the programme is that professionals remain receptive to the parents’ questions, working actively to strengthen parental confidence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe two professionals are regarded essential resources in delivering the visits, and their collaborative approach in the family’s home forms the central pillar of the intervention. Having two professions allows the programme to cover a broad range of topics and respond to diverse family needs, while also providing multiple perspectives on early childhood development and parenting. Working consistently with the same partner enables the professionals to build a supportive dynamic, which is particularly valuable in complex or challenging situations [18].\u003c/p\u003e\n\u003cp\u003eFor families with additional needs, support can be extended beyond the six visits or offered through referrals to other services. Interpreters are available when required.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecruitment and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParents were recruited by CHC nurses and parental supporters involved in the programme, who were asked to identify participants for a strategic sample. The sampling aimed to ensure variation in gender, family type (single parents and couples), and parental experience, including both first-time parents and those having their first child in Sweden. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEach participating CHC centre was asked to contribute with a number of families proportional to its size. Parents were approached during the fifth or sixth home visit and informed about the study. The intention was to interview parents who had completed all six visits; however, exceptions were made for practical reasons (e.g., imminent relocation), and in a few cases, parents had completed only four or five visits.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSixteen families participated in the study. Most were first-time parents (\u003cem\u003en\u003c/em\u003e = 12) while others participated with their second (\u003cem\u003en\u003c/em\u003e = 3) or fourth child (\u003cem\u003en\u003c/em\u003e = 1). In total, 22 parents were interviewed, since some interviews included both parents (14 mothers and 8 fathers). Most participants had migrated to Sweden (\u003cem\u003en\u003c/em\u003e = 14). In eight families, one or both parents had lived in Sweden for less than three years. Two families were asylum seekers. Three families had parental migration background, while five participants had no familial migration history.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMost families consisted of married or cohabiting parents (\u003cem\u003en\u003c/em\u003e = 14), while two were single mothers. There was a predominance of girls (\u003cem\u003en\u003c/em\u003e = 10) over boys (\u003cem\u003en\u003c/em\u003e = 6) within the participating families. Housing conditions varied: some families lived in rental apartments (\u003cem\u003en\u003c/em\u003e = 9), others owned their homes (n = 5), while a few lacked permanent housing (\u003cem\u003en\u003c/em\u003e = 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Interviews were conducted when the child who had received the intervention was around 15 months old, although in some cases they took place later due to delays caused by the Covid-19 pandemic. In some instances, home visits had also been relocated to CHC centres or rescheduled in line with infection-control measures.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe interviews were carried out by the first author as conversations with open-ended questions which allowed the participants to talk freely about their experiences. A semi-structured interview guide was used to ensure that key topics were covered (see Appendix 1). The guide addressed areas such as parents’ experiences of the home visits, their perceptions of contact with professionals, the support provided, and how the programme related to their needs and circumstances.\u003c/p\u003e\n\u003cp\u003eMost interviews were conducted in participants’ homes (\u003cem\u003en\u003c/em\u003e = 13), while three were conducted by phone due to Covid-related restrictions or lack of stable housing. Interviews lasted approximately 60–90 minutes and were carried out in Swedish or English, sometimes with the support of authorized interpreters (\u003cem\u003en\u003c/em\u003e = 4). When both parents participated, or when an interpreter was present, interviews tended to be longer. Interpretations were made in Arabic, Persian, and Somali.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll but one interview were audio-recorded and transcribed verbatim, with participation in recording being voluntary. In the single case where recording was declined, the interviewer took detailed notes instead.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The interviews were analysed using reflexive thematic analysis [17,19]. The approach was primarily inductive but informed by sensitising concepts – such as trust, support, and transitions related to parenting and migration. The authors independently read and familiarised themselves with the material, generating initial codes. Through an iterative process, codes were compared, discussed, and refined into candidate themes and subthemes.\u003c/p\u003e\n\u003cp\u003eFollowing Braun and Clarke’s six phases, the transcripts were: (1) familiarised with, (2) coded, (3) searched for themes, (4) reviewed, (5) defined and named, and (6) reported. Coding focused on segments pertinent to parents’ experiences of the intervention. Themes were actively conceptualized, with transcripts and codes revisited multiple times until final definitions were established. Attention was paid both to cross-participant patterns and to variation associated with family structure, migration background, and perceived needs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe interviews reported here are the same dataset as in the earlier project report [15], but the analysis has since been revisited and further developed. Specifically, we refined the thematic structure by repeating phases 4–6 (reviewing, defining/naming, and reporting themes) in Braun and Clarke’s framework.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Ethical approval was obtained from the Swedish Ethical Review Authority (Etikprövningsmyndigheten), decision number Dnr 2019–05839, and the study adhered to national guidelines and applicable regulations for research involving human participants. Participants received written and oral information about the study in their preferred language and provided informed consent prior to participation. Confidentiality was safeguarded through anonymisation and secure data handling; no identifying information is presented in the published material.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearcher reflexivity\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The research team comprised psychologists and a social worker with clinical experience in child and family services and migration-related issues. Reflexivity was integrated throughout the process, particularly in interpreting interview data from families with diverse cultural and linguistic backgrounds. Efforts were made to minimise power dynamics during interviews, including when interpreters were present. In line with reflexivity [20], we acknowledge that our backgrounds and perspectives – such as generational and parental statuses (parent/grandparent) and professional experience supporting children, young people, and parents – shaped coding decisions and theme development, and enriched analytic discussions.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe aim of this study was to explore parents\u0026rsquo; experiences of the REHV programme in socioeconomically disadvantaged areas of Gothenburg. The qualitative analysis generated one overarching theme \u0026ndash; \u003cem\u003eTransition to parenthood\u003c/em\u003e \u0026ndash; which encompassed three main themes: \u003cem\u003enavigating early parenthood\u003c/em\u003e, \u003cem\u003ereceiving support and reassurance in the parental role\u003c/em\u003e, and \u003cem\u003ebuilding trust through relationships with professionals\u003c/em\u003e (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). These themes are further elaborated in eight subthemes and illustrated in the text with selected quotations.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eThemes describing parents\u0026rsquo; experiences of the extended home visiting programme\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverarching theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMain theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubtheme\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTransition to parenthood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNavigating early parenthood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLiving conditions\u003c/p\u003e \u003cp\u003eSocial networks\u003c/p\u003e \u003cp\u003eCultural shift\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReceiving reassurance and support in the parental role\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHome-based support\u003c/p\u003e \u003cp\u003eReassurance and guidance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBuilding trust through relationships with professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTrust in the staff\u003c/p\u003e \u003cp\u003eIndividualised and adaptable support\u003c/p\u003e \u003cp\u003eComplementary expertise\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThe table summarises the overarching theme, main themes, and subthemes derived from the reflexive thematic analysis of interviews with parents participating in the extended home visiting programme.\u003c/em\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eNavigating early parenthood\u003c/h2\u003e \u003cp\u003eBecoming a parent was often described as a profound process of adaptation \u0026ndash; a transition that, for some, was compounded by a \u0026ldquo;double transition\u0026rdquo;: adjusting to parenthood while simultaneously adapting to a new society. Parents spoke of trying to find their footing in this unfamiliar situation and to attune themselves to the needs of their baby. Various external circumstances were experienced as barriers to this process. While some families lived in relatively stable conditions and had access to supportive networks, others described considerable vulnerability related to migration, housing insecurity, social isolation, and limited familiarity with Swedish society and culture. These contextual factors shaped how the REHV programme was perceived and received.\u003c/p\u003e \u003cp\u003e\u003cem\u003eLiving conditions\u003c/em\u003e varied considerably across participants, including differences in migration background, employment status, and family structure (e.g. cohabiting couples versus single parents). Parents who were asylum seekers described themselves as particularly vulnerable, as their daily lives were marked by uncertainty about their right to stay in Sweden. Another significant factor was whether the family had access to secure housing and financial stability. \u0026ldquo;The lack of housing and not to be able to get help from the unemployment security, or the employment agency is hard.\u0026ldquo; (first-time mother without own migration history)\u003c/p\u003e \u003cp\u003eMoreover, many families lived in neighbourhoods where they did not feel safe due to crime and violence, expressing that they did not want to raise their children in the area.\u003c/p\u003e \u003cp\u003e\u0026ldquo;There are a lot of problems in this neighbourhood. Every evening the police are here, and ambulances, and cars are set on fire. And there are a lot of gangs running around in the area (\u0026hellip;) I don\u0026rsquo;t want my children to grow up in this neighbourhood.\u0026rdquo; (father with two children and migration history)\u003c/p\u003e \u003cp\u003eFor parents with little or no \u003cem\u003esocial networks\u003c/em\u003e, feelings of isolation and emotional vulnerability were common, particularly during the first months with a newborn. Parents described being far from their extended families and experiencing difficulties in forming new relationships. As one parent who had moved to a new city without family or friends expressed: \u0026ldquo;Above all, it\u0026rsquo;s different because we\u0026rsquo;re new to this community [\u0026hellip;] it felt a bit scary to stand there alone with my child and have my parents so far away.\u0026rdquo; (first-time mother without own migration history)\u003c/p\u003e \u003cp\u003eSometimes, the language barrier intensified feelings of loneliness, even when parents were able to visit places where they could meet others:\u003c/p\u003e \u003cp\u003e\u0026ldquo;When I go to the open preschool, I see many other women there, and they speak Swedish, but I cannot speak Swedish. I don\u0026rsquo;t understand what they are saying\u0026hellip; so it is so difficult for me to\u0026hellip; communicate\u0026hellip; I can\u0026rsquo;t go anywhere\u0026hellip; I\u0026rsquo;m just visiting and sitting and watching, so it is not fun for me.\u0026rdquo; (mother of two children with migration history)\u003c/p\u003e \u003cp\u003eThe \u003cem\u003ecultural shift\u003c/em\u003e in parenting expectations was also a recurring theme. Parents contrasted their experiences in Sweden with traditions in their countries of origin, where parenting was typically embedded within extended family structures and responsibilities were shared among relatives. For parents who had previously raised children outside Sweden, the situation in the new country was described as so different that they felt like becoming a first-time parent again:\u003c/p\u003e \u003cp\u003e\u0026ldquo;It\u0026rsquo;s like I am starting all over again. [\u0026hellip;] I must do everything now; there is no one I can turn to. I must do everything myself. [\u0026hellip;] My home country and Sweden are different. When you give birth there, all the family is close. You get a lot of help \u0026ndash; you could sleep a few hours, and my mother or grandmother or some relative was at home taking care of the children and helping out. It is different (\u0026hellip;) People there are there to help you, because in XX [the country] when a mother has a baby, people come and\u0026hellip; bathe you, massage you, and you don\u0026rsquo;t have to do anything or go anywhere (\u0026hellip;) they bring you food. All you do is eat and breastfeed the baby. You do that for three months before you even start going out again.\u0026rdquo; (mother of two children with migration history)\u003c/p\u003e \u003cp\u003e In sum, parents described how their living conditions, limited social networks, and the cultural shift involved in raising a child in a new society shaped their emotional state, expectations, and support needs. These intertwined challenges made the presence of consistent and supportive professionals particularly meaningful.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eReceiving reassurance and support in the parental role\u003c/h2\u003e \u003cp\u003eThe fact that the professionals came to the families\u0026rsquo; homes was described as fostering more equal and open relationships with the professionals. Parents consistently emphasized the value of receiving \u003cem\u003ehome-based support\u003c/em\u003e, particularly during the emotionally intense early stages of parenthood. The home environment was described as psychologically reassuring, less stressful than clinic-based visits, and more conducive to open conversation. \u0026ldquo;They come home and they know about children, and I feel there\u0026rsquo;s something familiar about them coming home \u0026ndash; it\u0026rsquo;s a psychological thing. I can feel so safe.\u0026rdquo;\u003c/p\u003e \u003cp\u003e(first-time mother without migration history)\u003c/p\u003e \u003cp\u003eBeing at home made it easier to discuss practical matters, such as feeding and sleeping arrangements, by allowing parents to demonstrate these routines directly in their everyday environment. Moreover, being at home made it easier for the child to display its natural behaviour compared to in the unfamiliar environment of the CHC centre, which further enriched the \u003cem\u003eguidance\u003c/em\u003e they received.\u003c/p\u003e \u003cp\u003eParents also emphasised that they valued the \u003cem\u003ereassurance and guidance\u003c/em\u003e provided by the staff. This reassurance was described as particularly important for those who lacked strong support networks or felt uncertain in their new role. Being met without judgement and having their efforts acknowledged had a strong emotional impact: \u0026ldquo;The biggest gain for me has been that I am enough [\u0026hellip;] The best part was not having to compare myself to others.\u0026rdquo; (first-time mother without migration history)\u003c/p\u003e \u003cp\u003eThe professionals provided concrete guidance, both in relation to child development and the parents\u0026rsquo; own wellbeing. Fathers, in particular, emphasized that they had learned how to engage more actively in infant care and to share responsibilities with their partners: \u0026ldquo;We got very good guidance [\u0026hellip;]. Raising a child isn\u0026rsquo;t easy \u0026ndash; you must cooperate and share the responsibility.\u0026rdquo; (first-time father with two children and migration history)\u003c/p\u003e \u003cp\u003eParents appreciated receiving knowledge from the staff about their child\u0026rsquo;s needs, tailored to each child\u0026rsquo;s developmental stage. The information encompassed a wide range of topics, including nutrition, sleep, ways to stimulate development, and child safety.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Actually, it was informative, because, well, you could get this sufficient information. They mentioned that if the child is not walking, how to support it...They also mentioned teaching the child what things are called. NN (the nurse), she provided most of the information about the child's development, what happened during these periods...and she gave me some insight because, you know, I don't have a lot of knowledge since I was \u0026ndash; I am so young.\u0026ldquo; (young first-time single mother without own migration history)\u003c/p\u003e \u003cp\u003e In sum, parents highlighted that receiving reassurance and guidance in the parental role \u0026ndash; delivered in their own homes - combined emotional validation, practical advice, and culturally responsive information in a way that strengthened their confidence and reduced uncertainty. The home-based format was experienced as especially valuable for those facing isolation, unfamiliarity with Swedish systems, or limited access to other sources of support.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBuilding trust through relationships with professionals\u003c/h2\u003e \u003cp\u003e Most parents experienced that they had developed trustful relationships with the professionals, grounded in continuity, flexibility, and complementary roles. Parents emphasized that such trust was a prerequisite for accepting support from professionals.\u003c/p\u003e \u003cp\u003eContinuity of staff \u0026ndash; that they consistently met the same individuals over time \u0026ndash; was regarded as a key element in building \u003cem\u003etrust in the staff\u003c/em\u003e. Trust was also linked to feelings of being listened to and validated as a parent, as well as to receiving reliable knowledge about the child\u0026rsquo;s needs. Several parents emphasized that trust in the staff was necessary to enable them to address sensitive issues. Trust was associated with feeling safe, which required both time and stability in the relationship. \u0026ldquo;It\u0026rsquo;s absolutely crucial (\u0026hellip;) opening up is hard [\u0026hellip;] if new people kept coming, you wouldn\u0026rsquo;t feel like opening up.\u0026rdquo; (first-time mother without migration history)\u003c/p\u003e \u003cp\u003eThe threshold for contacting the staff was described as low, which in turn fostered a sense of safety in the relationship:\u003c/p\u003e \u003cp\u003e\u0026ldquo;They tell us, you must not wait until the next visit. Whatever happens, small or big things, you can call us (\u0026hellip;) We feel that there is always support behind us, always someone there. If my parents aren\u0026rsquo;t here and her parents are not here, we felt that there was always someone holding us and supporting us.\u0026rdquo; (first-time father with migration history)\u003c/p\u003e \u003cp\u003eAnother aspect of creating trustworthy relationships concerned the flexibility of the programme. Most parents experienced that they had received \u003cem\u003eindividualised and adaptable support\u003c/em\u003e according to their own needs \u0026ndash; for example, that the staff adapted the content of the home visits to the parents\u0026rsquo; questions and concerns, and that appointments could be scheduled at times when the fathers were able to participate.\u003c/p\u003e \u003cp\u003eFor families with additional needs, support was also extended beyond the regular visits, as the programme allowed for additional meetings. These extra sessions could include guidance on breastfeeding, and assistance in contacting welfare authorities (for example, for help with financial difficulties, housing challenges, or psychological wellbeing). In some cases, the staff arranged separate meetings to ensure enough time to discuss these issues in dept and to offer support based on their own expertise. In other cases, they helped the parent to get in contact with other professionals or organisations that could provide further assistance. The parental supporters provided information about parents\u0026rsquo; rights within the welfare system and could also accompany parents to community activities where they could meet other parents, thereby helping to reduce social isolation. \u0026ldquo;She, the parental supporter... I actually called her several times. \u003cem\u003e(\u0026hellip;)\u003c/em\u003e with the child benefit, she helped me several times \u0026ndash; she even called the Social Insurance Agency\u0026hellip;. She also helped with the maintenance allowance.\u0026rdquo; (first-time single mother without migration history)\u003c/p\u003e \u003cp\u003eParents emphasized that the two professionals \u0026ndash; the CHC nurse and the parental supporter \u0026ndash; contributed \u003cem\u003ecomplementary expertise\u003c/em\u003e. The nurse primarily focused on child health and development, while the parental supporter addressed broader concerns such as the couple relationship, psychosocial support, and guidance on available social services. This dual approach was perceived as one of the programme\u0026rsquo;s distinctive strengths. \u0026ldquo;It was good with both because they complemented each other [\u0026hellip;] They had different areas of expertise.\u0026rdquo; (first-time father with migration history).\u003c/p\u003e \u003cp\u003eAltogether, the continuity and dependability of the staff, the flexible and individualised support, and the complementary expertise of the two professionals formed the basis for trustful relationships in which parents felt able to address difficult questions, show vulnerability, and strengthen their confidence in the wider welfare system.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe Rinkeby Extended Home Visiting (REHV) programme offers structured home visits by a child health care (CHC) nurse and a parental supporter from preventive social services. In Gothenburg, the model was adapted to include both first-time parents and those having their first child in Sweden, acknowledging that previous parenting experience may not always transfer across cultural and systemic contexts. This study explores parents\u0026rsquo; own perspectives through in-depth interviews, providing deeper insights into how parents living in disadvantaged areas perceived and valued the programme.\u003c/p\u003e \u003cp\u003eAn overarching theme emerged in the results: the transition to parenthood, connected with the subthemes navigating early parenthood, receiving reassurance and support in the parental role, and building trust through relationships with professionals. Together, these findings shed light on the relational and contextual processes through which extended home visiting can promote equity in early childhood development.\u003c/p\u003e \u003cp\u003e Parents described diverse and sometimes precarious circumstances: some had stable living conditions and strong social networks, while others faced insecure housing, social isolation, and migration-related stress. For families with migration backgrounds, the transition to parenthood in Sweden involved a \u0026ldquo;double transition\u0026rdquo;\u0026mdash; adapting to both a new life stage and an unfamiliar society. These parents needed to relate to a cultural shift. Many contrasted the individualised Swedish model of parenthood with practices in their countries of origin, where extended family networks typically shared childcare responsibilities. Such accounts echo earlier findings from the Rinkeby model, highlighting how structural disadvantage and cultural dislocation shape parents\u0026rsquo; experiences of support [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSwedish-born parents did not describe the same cultural shift, but reported challenges linked to poverty, neighborhood insecurity, and weak social networks. This aligns with research showing persistent health inequalities among children living in socioeconomically disadvantaged areas and the need for proportionate universalism [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Parents emphasised that receiving support at home was reassuring and lowered the threshold for engagement. The home environment enabled parents to relax more than in the clinic-based setting, making it easier to feel safe and to open up about sensitive issues. This is in line with earlier research showing that home visits can foster trust and openness in sensitive conversations [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBeing at home also allowed the professionals to observe the child in everyday routines and to tailor guidance accordingly, which made the support more concrete and practical. The combination of emotional validation, practical advice, and culturally responsive information helped parents gain confidence and reduced feelings of isolation. Beyond reassurance, parents described that being told they were doing well gave them a sense of pride and empowerment in their new role, resonating with earlier Swedish studies [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese findings also align with Al-Adhami and colleagues [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], who found that home-based visits provided both emotional reassurance and informational support, enabling parents to build confidence and trust in professionals. Their study underscores how tailored, relationship-centred home visiting can reduce parental stress and increase accessibility for families with diverse backgrounds.\u003c/p\u003e \u003cp\u003eTaken together, these findings resonate with international research showing that home-based, relationship-focused interventions can strengthen parental confidence and improve access to services [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Parents consistently described trust as a prerequisite for accepting professional support. Continuity of staff, non-judgmental attitudes, and the low threshold for contact between visits were central to this trust. Parents valued the dual-professional model: nurses provided health and developmental expertise, while parental supporters offered psychosocial guidance and help navigating welfare systems. This complementarity was perceived as particularly important for families facing multiple disadvantages. The importance of trust and relational continuity is also reinforced by Al-Adhami and colleagues [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], who highlight how ongoing relationships and accessibility are essential for fostering parents\u0026rsquo; sense of security and willingness to seek help.\u003c/p\u003e \u003cp\u003eThe findings align with the Nurturing Care Framework [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] which emphasises integrated health, caregiving, and social support, and with evidence that interprofessional collaboration enhances equity in early years services [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] (Barboza et al., 2022; Franz\u0026eacute;n \u0026amp; Nilsson, 2024; Gols\u0026auml;ter \u0026amp; Andersson, 2024).\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003e A key strength of this study is its emphasis on parents\u0026rsquo; own voices, providing an in-depth perspective on the REHV programme that has not previously been documented. The depth of the analysis was supported by the interviewer\u0026rsquo;s responsiveness to the parents\u0026rsquo; narratives and by the fact that almost all interviews were conducted in the families\u0026rsquo; homes. The sample was strategically varied in terms of residential area, gender, family structure, and migration background, which enhanced the diversity of perspectives.\u003c/p\u003e \u003cp\u003eLimitations include that some interviews were conducted with interpreters, which may have led to loss of nuance despite the use of authorised professionals. Finally, as a single-city study, transferability may be limited; however, the findings offer analytic insights that may be relevant to other urban contexts characterised by segregation and inequality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eImplications and conclusion\u003c/h2\u003e \u003cp\u003eThe findings suggest that extended home visiting programmes\u0026mdash;when designed with attention to equity, cultural sensitivity, and relational continuity\u0026mdash;can play a key role in supporting families living in socioeconomically disadvantaged areas, enhancing their capacity to give children a strong start in life. These programmes are particularly pertinent in urban settings characterised by segregation and structural barriers to health and social services.\u003c/p\u003e \u003cp\u003eConsistent with Al-Adhami and colleagues [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], the results highlight the potential of home-based, trust-oriented interventions to strengthen parental confidence, reduce social isolation, and facilitate connections to services. By prioritising trust, accessibility, and the dual transitions of parenting and migration, the REHV programme was experienced as both practical and empowering. These insights underscore the promise of proportionate, relationship-based models in promoting equity and supporting optimal early childhood development.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCHC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChild Health Care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eREHV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRinkeby Extended Home Visiting\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Swedish Ethical Review Authority (Dnr 2019–05839). All participants provided oral and written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided informed consent for the publication of the analyzed and thematised interview data. Only anonymized excerpts are included, and no identifying information is presented in the published material.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn accordance with Swedish legislation regulating research involving human participants, and to safeguard the confidentiality and integrity of the individuals who participated in the study, the interview transcripts that constitute the primary data cannot be made publicly available. Nonetheless, illustrative excerpts from the material have been incorporated into the manuscript where appropriate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEconomic support for this research was provided by Gothenburg City and Region Västra Götaland.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: LL, EA; methodology: LL, EA; formal analysis: LL, EA; visualization: LL, EA; investigation: LL; writing – original draft preparation: LL, JO; writing – review and editing, LL, JO, EA; project administration, LL. All authors read and approved the final manuscript. Note. LL = Lisbeth Lindahl, EA = Elin Alfredsson, JO = Jeanette Olsson.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe gratefully acknowledge all participating parents, the interpreters who assisted during the interviews, and the professionals in the REHV programme in Gothenburg who supported the recruitment of informants for the study. Special thanks also to Louise Bäckemo Johansson for her valuable contributions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSocialdepartementet. N\u0026auml;sta steg p\u0026aring; v\u0026auml;gen mot en mer j\u0026auml;mlik h\u0026auml;lsa \u0026ndash; F\u0026ouml;rslag f\u0026ouml;r ett l\u0026aring;ngsiktigt arbete f\u0026ouml;r en god och j\u0026auml;mlik h\u0026auml;lsa. SOU 2017:47. Stockholm: Statens Offentliga Utredningar; 2017.\u003c/li\u003e\n \u003cli\u003eWallby T, Hjern A. Child health care uptake among low-income and immigrant families in a Swedish county. Acta Paediatr. 2011;100(11):1495\u0026ndash;503.\u003c/li\u003e\n \u003cli\u003eBarboza M. Utv\u0026auml;rdering av ut\u0026ouml;kade hembes\u0026ouml;k: L\u0026aring;ngsiktiga effekter i Rinkeby. Stockholm: Karolinska Institutet; 2022.\u003c/li\u003e\n \u003cli\u003eDegni F, Suominen S, Ess\u0026eacute;n B, El Ansari W, Vehvil\u0026auml;inen-Julkunen K. Communication and cultural issues in providing reproductive health care to immigrant women: Health care providers\u0026rsquo; experiences in meeting Somali women living in Finland. J Immigr Minor Health. 2006;8(2):113\u0026ndash;23.\u003c/li\u003e\n \u003cli\u003eOlds DL, Kitzman H, Cole R, Hanks C, Arcoleo K, Anson E, et al. Effects of nurse home visiting on maternal and child functioning: Age-nine follow-up of a randomized trial. Pediatrics. 2007;120(4):e832\u0026ndash;45.\u003c/li\u003e\n \u003cli\u003ePeacock S, Konrad S, Watson E, Nickel D, Muhajarine N. Effectiveness of home visiting programs on child outcomes: A systematic review. BMC Public Health. 2013;13:17.\u003c/li\u003e\n \u003cli\u003eMarttila A, Johansson M, Burstr\u0026ouml;m B, Kulane A. Implementation of extended home visits in a disadvantaged area in Stockholm, Sweden: Parental and professional perspectives. Prim Health Care Res Dev. 2017;18(4):365\u0026ndash;75.\u003c/li\u003e\n \u003cli\u003eMarmot M. Fair society, healthy lives: The Marmot Review. Strategic review of health inequalities in England post-2010. London: The Marmot Review; 2010.\u003c/li\u003e\n \u003cli\u003eLindahl L, Alfredsson E. Att finna sin roll, att s\u0026aring; ett fr\u0026ouml; \u0026ndash; f\u0026ouml;r\u0026auml;ldrast\u0026ouml;djarnas arbete i barnh\u0026auml;lsov\u0026aring;rden. G\u0026ouml;teborg: G\u0026ouml;teborgsregionen, FoU i V\u0026auml;st; 2022.\u003c/li\u003e\n \u003cli\u003eBarboza M, Burstr\u0026ouml;m B, Marttila A. A health promotion programme for parents and children in a disadvantaged area in Sweden: A qualitative study of the participants\u0026rsquo; experience. Health Soc Care Community. 2021;29(5):1457\u0026ndash;65.\u003c/li\u003e\n \u003cli\u003eBurstr\u0026ouml;m B, Marttila A, Kulane A, Barboza M. Extended home visits to new parents in Rinkeby, Sweden: A qualitative study of health visitor and parental perspectives. Scand J Public Health. 2020;48(5):534\u0026ndash;41.\u003c/li\u003e\n \u003cli\u003eB\u0026auml;ckstr\u0026ouml;m C, Barboza M, Thorstensson S. Parents\u0026rsquo; experiences of receiving professional support through extended home visits during the child\u0026rsquo;s first 15 months: A phenomenographic study. Scand J Caring Sci. 2021;35(2):437\u0026ndash;45.\u003c/li\u003e\n \u003cli\u003eSj\u0026ouml;gren Forss K, Mangrio E, Persson K. First-time parents\u0026rsquo; experiences of a combined home visit by a midwife and child health care nurse within the Swedish Child Health Care: A qualitative study. BMC Health Serv Res. 2022;22(1):257.\u003c/li\u003e\n \u003cli\u003eAl-Adhami M, Kornaros KG, L\u0026ouml;nnberg G. Supported in a time of need \u0026ndash; First-time parents\u0026rsquo; perceptions of a Swedish extended home visiting program. BMC Prim Care. 2025;26(1):281.\u003c/li\u003e\n \u003cli\u003eLindahl L, Alfredsson A, Petrini E, B\u0026auml;ckemo Johansson L. Betydelser och effekter av ut\u0026ouml;kade hembes\u0026ouml;k i G\u0026ouml;teborg. G\u0026ouml;teborg: FoU i V\u0026auml;st; 2023.\u003c/li\u003e\n \u003cli\u003eBerger PL, Luckmann T. The social construction of reality : a treatise in the sociology of knowledge. 1st ed. New York: Anchor Books; 1967. 288 p.\u003c/li\u003e\n \u003cli\u003eBraun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019 Aug 8;11(4):589-97.\u003c/li\u003e\n \u003cli\u003eBarboza M, Marttila A, Burstr\u0026ouml;m B, Kulane A. Towards health equity: core components of an extended home visiting intervention in disadvantaged areas of Sweden. BMC Public Health. 2022;22:1091.\u003c/li\u003e\n \u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77\u0026ndash;101.\u003c/li\u003e\n \u003cli\u003eElliott R, Fischer CT, Rennie DL. Evolving guidelines for publication of qualitative research studies in psychology and related fields. Br J Clin Psychol. 1999;38(3):215\u0026ndash;29.\u003c/li\u003e\n \u003cli\u003eGols\u0026auml;ter M, Andersson A-C. Collaborative extended home-visits as a key to facilitating early support within the frame of a family centre in Sweden. BMC Health Serv Res. 2024;24:1532.\u003c/li\u003e\n \u003cli\u003eMcDonald M, Moore TG, Goldfeld S. Sustained nurse home visiting for families and children: A review of effective programs. Melbourne: Murdoch Children\u0026rsquo;s Research Institute; 2019.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. Nurturing care for early childhood development: A framework for helping children survive and thrive to transform health and human potential. Geneva: WHO; 2018.\u003c/li\u003e\n \u003cli\u003eFranz\u0026eacute;n K, Nilsson S. Supporting first-time parents in their homes: Boundary work in interprofessional collaboration within an extended home visiting programme. Front Public Health. 2024;12:1389910.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-for-equity-in-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijeh","sideBox":"Learn more about [International Journal for Equity in Health](http://equityhealthj.biomedcentral.com)","snPcode":"12939","submissionUrl":"https://submission.nature.com/new-submission/12939/3","title":"International Journal for Equity in Health","twitterHandle":"@equityhealthj","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"child health services, early child development, extended home visiting, health equity, interprofessional collaboration, migration, parental support, prevention, qualitative research, transition to parenthood","lastPublishedDoi":"10.21203/rs.3.rs-8360510/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8360510/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEarly childhood represents a critical period for promoting health equity, particularly for families facing social and economic disadvantage. In Sweden, extended home visiting programmes have been introduced to strengthen early preventive support for first-time parents in disadvantaged areas. This study explored how parents experienced such a programme in Gothenburg, Sweden, with attention to trust-building, accessibility, and perceived support.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative design was used. Semi-structured interviews were conducted with 22 parents from 16 families who had participated in the Rinkeby Extended Home Visiting programme. Participants were strategically selected to capture variation in gender, family structure, and migration background. Interviews were analysed using reflexive thematic analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOne overarching theme \u0026ndash; Transition to parenthood \u0026ndash; encompassed three main themes: \u003cem\u003enavigating early parenthood\u003c/em\u003e, \u003cem\u003ereceiving reassurance and support in the parental role\u003c/em\u003e, and \u003cem\u003ebuilding trust through relationships with professionals\u003c/em\u003e. Parents described the early months as emotionally intense, often marked by isolation, insecure housing, or migration-related stress. Home-based visits provided reassurance, practical guidance, and emotional validation. The combination of a nurse and a parental supporter offered complementary expertise and was seen as a key strength. Trust developed through continuity, respect, and flexibility, which enabled open communication and acceptance of support.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eExtended home visiting was experienced as meaningful, empowering, and accessible for families facing social disadvantage. Its relational, home-based, and interprofessional approach fostered trust and strengthened parental confidence. These findings illustrate how proportionate, equity-focused interventions can support parents and promote healthy early child development in diverse urban settings.\u003c/p\u003e","manuscriptTitle":"Transition to Parenthood: Parents’ Experiences of a Home Visiting Programme in Disadvantaged Areas of Sweden","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-14 07:11:55","doi":"10.21203/rs.3.rs-8360510/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-26T12:52:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-26T09:46:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"283611453379701732035096791402835335016","date":"2026-01-16T08:08:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-12T09:51:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-24T18:28:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-24T07:37:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal for Equity in Health","date":"2025-12-24T00:13:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-for-equity-in-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijeh","sideBox":"Learn more about [International Journal for Equity in Health](http://equityhealthj.biomedcentral.com)","snPcode":"12939","submissionUrl":"https://submission.nature.com/new-submission/12939/3","title":"International Journal for Equity in Health","twitterHandle":"@equityhealthj","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"33eedcc5-f805-4413-aea1-04b687996d06","owner":[],"postedDate":"January 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T16:11:25+00:00","versionOfRecord":{"articleIdentity":"rs-8360510","link":"https://doi.org/10.1186/s12939-026-02822-1","journal":{"identity":"international-journal-for-equity-in-health","isVorOnly":false,"title":"International Journal for Equity in Health"},"publishedOn":"2026-03-21 15:58:38","publishedOnDateReadable":"March 21st, 2026"},"versionCreatedAt":"2026-01-14 07:11:55","video":"","vorDoi":"10.1186/s12939-026-02822-1","vorDoiUrl":"https://doi.org/10.1186/s12939-026-02822-1","workflowStages":[]},"version":"v1","identity":"rs-8360510","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8360510","identity":"rs-8360510","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}