Child representatives’ conceptions of children's participation in prehospital emergency care: A phenomenographic study

Background Children have the right to be heard and to participate in their care. Despite this, participation is not consistently realised in practice, particularly in prehospital emergency care. In Sweden, some healthcare services appoint child representatives, staff members with designated responsibility for safeguarding the child's perspective. Aim To explore child representatives’ conceptions of children's participation in prehospital emergency care. Methods A qualitative study using a phenomenographic approach was conducted. Semi-structured interviews were conducted with child representatives working in the Swedish Ambulance Service. Data were analysed to identify qualitatively distinct ways in which children's participation in prehospital emergency care was conceived. Results Three hierarchical descriptive categories were identified: (1) children's participation was conceived as shaped by ambulance clinicians’ attitudes and experience; (2) children's participation was conceived as conditioned by age, developmental level, and situational urgency; and (3) children's participation was conceived as influenced by the adult-oriented ambulance environment. Ambulance clinicians’ attitudes and experience were understood as the overarching factor, shaping how contextual and environmental conditions came to matter in the care encounter. Participation was conceived as more constrained in very young children and in time-critical situations, but more likely when ambulance clinicians adapted communication and care to the individual child. Conclusion Children's participation in prehospital emergency care was conceived as being shaped primarily by ambulance clinicians’ attitudes and experience. Supporting participation, therefore, requires more than protocol adherence; it requires child-responsive communication, relational engagement, and adaptation to the child's developmental level and situation.