Child health promotion in the United Kingdom: does health visitors’ practice follow policy?

Abstract

This paper is a report of a study to assess to what extent national child health promotion policy is reflected in health visitors' practice across the United Kingdom. Community or public health nurses are often key providers of child health promotion programmes for well children. Over the last decade, national United Kingdom policy concerning universal preventive health services for preschool children has changed rapidly. Health promotion contacts are increasingly targeted to those with the highest health needs. A survey was conducted in 2005 of health visitors' Child Health Promotion Programme practice. A postal questionnaire exploring local practice and policy was sent to a random 10% sample of Registered Health Visitors. Respondents were from all four countries of the UK although predominantly (90%) from England. Nominal data were analysed by frequencies and associations between key variables. The chi-square test was used for comparisons between groups of respondents, with a statistical significance level of P < 0.05. A 64% response rate (n = 1537) was obtained, with 1043 questionnaires from current practitioners. While three-quarters of respondents stated that the number of routine contacts recommended in local policy had decreased since revision of the Child Health Promotion Programme, 39% stated that targeted contacts had increased. Just over a third agreed that contact should be targeted to children with identified needs after 1 year of age. As child health promotion programmes play a major part in well-child care internationally, it is important to take into account diversity in practice, and potential conflicts between professional values and policy.