Research Article: Realist evaluation of an enhanced health visiting programme

Date Published: July 3, 2017

Publisher: Public Library of Science

Author(s): Lawrence Doi, Ruth Jepson, Samantha Hardie, Fiona Harris.

http://doi.org/10.1371/journal.pone.0180569

Abstract

The health visitors’ role in many countries is changing. In Scotland, the role has undergone substantial changes through the introduction of an enhanced health visiting programme, which includes increased, structured home visits. This evaluation was conducted within NHS Ayrshire and Arran, one of the 14 Scottish Health Boards. Our aim was to understand and explain how, and why, the programme could contribute to improving health and wellbeing outcomes for children and families.

We used a realist evaluation approach, conducted in three phases. In phase one, eight managerial staff involved in developing and implementing the programme provided data, which were used to develop initial programme theories. In phase two, the programme theories were tested using qualitative data from 25 health visitors and 22 parents. The programme theories were refined through analyses and interpretation of data in phase three.

The home visiting context provided by the programme interacted with the mechanisms of the programme and produced outcomes such as early identification of health and wellbeing issues amongst families who needed more support, leading to referral and engagement with sources of additional help. The home visits facilitated development of parent-health visitor relationships, and parents considered health visitors as their first point of contact on children’s wellbeing and developmental-related issues. Moreover, the programme provided more clarity to health visitors’ role, which in turn enhanced partnership working. However, there were aspects of the programme that may require further development. For instance, both parents and health visitors were concerned about the wide gaps between some home visits.

The enhanced health visiting programme increased opportunities for monitoring and early identification of health and wellbeing concerns. It created structures for a more efficient partnership working and ensured that the needs of children and families were supported. These benefits need to be evaluated further in an effectiveness study.

Partial Text

The provision of a quality healthcare programme that promotes universal access to healthcare in early years has the potential to reduce health inequalities in later life [1, 2]. An example in the UK is the universal child health programme, often but not solely provided by the public health nursing services, and delivered by health visitors (may be called public health nurses or community nurses in other countries). Historically, health visiting has had a preventive nursing role and encompassed an integrated package of immunisation, screening, surveillance, health promotion and parenting support for families and children from birth to about 5 years of age [3, 4]. In the USA, early public health nursing roles also included advocacy, community organising, health education, and political and social reform, but this has changed to focus more on collaboration and partnerships with communities to address social problems in recent years [5]. The ultimate goal of most health visiting or public health nursing role is to improve outcomes for children, in spite of subtle differences that may exist across countries.

This study was designed to evaluate how and why an EHV programme implemented in an early adopter site in Scotland could contribute to improving health and wellbeing outcomes for children and families. We used a realist evaluation approach, as it is considered a valuable alternative to the more traditional paradigm to understanding nursing and healthcare issues and provides an insight into how programmes work [25]. With health visiting practice playing a crucial role in health improvement and reducing health inequalities, this study identified some important dimensions of the EHV programme that can contribute to this agenda. The EHV appears to have improved early identification of health and wellbeing concerns amongst families who needed more support, leading to referral and engagement with sources of additional help. The home visiting context facilitated development of parent-health visitor relationships, as parents considered health visitors as their first point of contact on children’s wellbeing and developmental-related issues. More so, the EHV programme provided role clarity to health visitors, which in turn, enhanced collaborative partnerships. However, there were aspects of the EHV, which would require further consideration. For instance, both parents and health visitors were concerned about the wide gaps between some assessment visits and the cumbersome nature of the referral pathways.

Our study highlighted key benefits of the enhanced health visiting programme. The programme increased opportunities for monitoring and early identification of health and wellbeing concerns. It created structures for a more efficient partnership working and ensured that the needs of children and families were supported. These benefits need to be evaluated further in an effectiveness study.

 

Source:

http://doi.org/10.1371/journal.pone.0180569

 

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