As in many other Western countries, telenurses are the first line of health care in Sweden [1, 2]. The Swedish national telephone health service, Swedish Healthcare Direct 1177 (SHD), was implemented in 2003 and is now available to the whole Swedish population (9.4 million people). The yearly prognosis is approximately six million calls, answered by more than a thousand telenurses employed at the service. Due to reports that at least 40% of health calls deal with children [2-5], the estimation for pediatric health calls is above 2.4 million calls a year. Children are hence frequent patients but generally not frequent callers, as most pediatric health calls are made by parents. For the telenurses, this means second-hand consultations, reported to be problematic , and also dealing with a vulnerable patient group . There are various opinions as to whether pediatric health calls are safe [8-10] or not . Moreover, parents have reported both high [12, 13] and low  satisfaction with the telephone service. Examples of dissatisfaction include parents who felt they were not treated with respect , and fathers who rated service quality lower than mothers . To date, however, parents’ expectations and experiences of calling SHD seem to be sparsely researched, in contrast to the numerous reports on telenursing work [6, 17-20]. Parents’ views and inherent knowledge  are important, as they can contribute to and influence service and safety development.
Mothers have previously been found to make a majority (73%) of the pediatric health calls in Sweden , congruent with other countries [23-25]. This suggests a possible gendered pattern in pediatric health calls, which may be due to greater trust in a mothers’ ability to talk to a telenurse . This in turn may reflect gendered roles in the family and gender norms in society . These gendered roles can be looked upon as a set of social and behavioural norms which govern what is considered to be socially appropriate for individuals of a specific sex . Being a woman or a man is contextually and relationally constructed . Hence “doing gender”  is a continuous ongoing process. Motherhood is strongly associated with femininity in most societies. As such, making pediatric health calls may be included in the construction of femininity . In this view, contacting health services is not included in fathers’ construction of masculinity to the same extent . Goode et al. , however, indicate diverse roles for male callers, with both traditional masculinity and models of a ‘new man/dad’. They argue that fathers’ involvement in their children’s contacts with health services will increase as it becomes more socially acceptable and expected for fathers to do so. It seems, however, that this involvement is developing slowly [22, 31, 32]. Why mothers make the majority of pediatric health calls may be connected to power relations [27, 28, 33], as mothers may exclude fathers from calling SHD.
According to the gender order, women possess less power than men , particularly in public contexts [34, 35]. However, in relation to the private sphere, e.g. caring for children and family, women instead commonly possess more power than men . It may thus be a double deprivation for mothers to pass on the responsibility of calling SHD to fathers, as it is not probable they would gain power in exchange. Furthermore, since 90% of the telenursing workforce in Sweden is female, it is also possible that fathers’ feelings of not being treated respectfully  and lower ratings of the service  can be due to observations that some female telenurses find it more complicated to communicate with men than women , and find it easier to convince women to “wait and see” . This may explain why the likelihood for a father to receive a referral as the result of a call was almost twice as great as for a mother (despite no signs of the ‘father’ calls being more urgent), with the opposite regarding self-care advice . Consequently, the possibility exists that telenurses contribute to the construction of femininity and masculinity in pediatric health calls. In fact, power has also been highlighted as a central aspect of telenursing , with telenurses guarding the ‘health care gate’ . Perspectives of gender and power can be intertwined with social differentiations such as ethnicity, class, sexuality, age and dis/ability, often denominated intersectionality . For example, having a deprived socioeconomic situation, belonging to a minority ethnic group [39-41] or being aged above 65  play a part in decreased use of telephone health services (the latter in contrast to 65+ patients’ increased use of general practice care services ).
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(Author: Elenor Kaminsky, Marianne Carlsson, Marta Röing, Inger K. Holmström