Abstract
BackgroundRecognition of the importance of the early years in determining health and educational attainment and promotion of the World Health Organization Health for All (HFA) principles has led to an international trend towards community-based initiatives to improve developmental outcomes among socio-economically disadvantaged children. In this study we examine whether, Best Start, an Australian area-based initiative to improve child health was effective in improving access to Maternal and Child Health (MCH) services.MethodsThe study compares access to information, parental confidence and annual 3.5 year Ages and Stages visiting rates before (2001/02) and after (2004/05) the introduction of Best Start. Access to information and parental confidence were measured in surveys of parents with 3 year old children. There were 1666 surveys in the first wave and 1838 surveys in the second wave. The analysis of visiting rates for the 3.5 year Ages and Stages visit included all eligible Victorian children. Best Start sites included 1,739 eligible children in 2001/02 and 1437 eligible children in 2004/05. The comparable figures in the rest of the state were and 45, 497 and 45, 953 respectively.ResultsThere was a significant increase in attendance at the 3.5 year Ages and Stages visit in 2004/05 compared to 2001/02 in all areas. However the increase in attendance was significantly greater at Best Start sites than the rest of the state. Access to information and parental confidence improved over the course of the intervention in Best Start sites with MCH projects compared to other Best Start sites.ConclusionThese results suggest that community-based initiatives in disadvantaged areas may improve parents' access to child health information, improve their confidence and increase MCH service use. These outcomes suggest such programmes could potentially contribute to strategies to reduce child health inequalities.
Highlights
Recognition of the importance of the early years in determining health and educational attainment and promotion of the World Health Organization Health for All (HFA) principles has led to an international trend towards community-based initiatives to improve developmental outcomes among socio-economically disadvantaged children
Recognition of the importance of the early years in determining health and educational attainment has led to a number of specially designed, community-based initiatives to improve developmental outcomes among socioeconomically disadvantaged children. [1,2] This has been accompanied by increasing evidence that living in disadvantaged areas is associated with worse health. [3,4,5,6,7,8,9,10,11,12,13,14,15] This has resulted in a number of initiatives which aim to improve health outcomes through the development of community and service provider partnerships as a way of increasing co-ordination between services
These initiatives aim to identify and address important gaps in service provision so as to better meet community needs. They reflect a wider shift towards area-based interventions as part of the Health for All (HFA) principles promoted by the World Health Organization. [3]
Summary
Recognition of the importance of the early years in determining health and educational attainment and promotion of the World Health Organization Health for All (HFA) principles has led to an international trend towards community-based initiatives to improve developmental outcomes among socio-economically disadvantaged children. These initiatives aim to identify and address important gaps in service provision so as to better meet community needs In so doing, they reflect a wider shift towards area-based interventions as part of the Health for All (HFA) principles promoted by the World Health Organization. The evaluation of the program suggested that Sure Start areas were more effective than control areas in improving social development and increasing the use of child and family services [1] These findings have occurred against a backdrop of mixed evidence for the health benefits of area-based initiatives more generally. These findings have occurred against a backdrop of mixed evidence for the health benefits of area-based initiatives more generally. [5] This may be due to the interventions themselves, measurement issues and mobility from areas. [5] Reviews of the evidence of the health impacts of areabased interventions have highlighted the need to focus on the pathways through which interventions would be expected to influence health. [6,7,8] Most research on these interventions has tended to focus on health or developmental outcomes rather than intermediate stages in the pathway through which interventions would be expected to affect health status. [1,5,8] These intervening steps, around the use of early childhood services, are very important in terms of addressing health disadvantage in children where the deleterious effects of adverse exposures and health benefits of intervention may not show up till later in life
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