Best Start In Life Research Articles

The extent of implementation and perceptions of maternity and social care professionals about two interprofessional programs for care for pregnant women: a mixed methods study

BackgroundIn 2018, the Dutch government initiated the Solid Start program to provide each child with the best start in life. Key program elements are a biopsychosocial perspective on pregnancy and children’s development and stimulating local collaborations between social and health domains, with a specific focus on (future) families in vulnerable situations. Two programs for interprofessional collaboration between maternity and social care professionals to optimize care for pregnant women in vulnerable situations were developed and implemented, in Groningen in 2017 and in South Limburg in 2021. This paper describes the extent of implementation of these programs and the perceptions of involved professionals about determinants that influence program implementation.MethodsWe conducted a mixed-methods study in 2021 and 2022 in two Dutch regions, Groningen and South Limburg. Questionnaires were sent to primary care midwives, hospital-based midwives, obstetricians (i.e. maternity care professionals), (coordinating) youth health care nurses and social workers (i.e. social care professionals), involved in the execution of the programs. Semi-structured interviews were held with involved professionals to enrich the quantitative data. Quantitative and qualitative data were collected and analyzed using Fleuren's implementation model.ResultsThe findings of the questionnaire (n = 60) and interviews (n = 28) indicate that professionals in both regions are generally positive about the implemented programs. However, there was limited knowledge and use of the program in Groningen. Promoting factors for implementation were mentioned on the determinants for the innovation and the user. Maternity care professionals prefer a general, conversational way to identify vulnerabilities that connects to midwives’ daily practice. Low-threshold, personal contact with clear agreements for referral and consultation between professionals contributes to implementation. Professionals agree that properly identifying vulnerabilities and referring women to appropriate care is an important task and contributes to better care. On the determinants of the organization, professionals indicate some preconditions for successful implementation, such as clearly described roles and responsibilities, interprofessional training, time and financial resources.ConclusionsAreas for improvement for the implementation of interprofessional collaboration between maternity care and social care focus mainly on determinants of the organization, which should be addressed both regionally and nationally. In addition, sustainable implementation requires continuous awareness of influencing factors and a process of evaluation, adaptation and support of the target group.

Should Pregnant Women Consume Probiotics to Combat Endocrine-Disrupting Chemical-Induced Health Risks to Their Unborn Offspring?

Endocrine-disrupting chemicals (EDCs) have become so pervasive in our environment and daily lives that it is impossible to avoid contact with such compounds, including pregnant women seeking to minimize exposures to themselves and their unborn children. Developmental exposure of humans and rodent models to bisphenol A (BPA) and other EDCs is linked to increased anxiogenic behaviors, learning and memory deficits, and decreased socio-sexual behaviors. Prenatal exposure to BPA and other EDCs leads to longstanding and harmful effects on gut microbiota with reductions in beneficial bacteria, i.e., gut dysbiosis, and such microbial changes are linked to host changes in fecal metabolites, including those involved in carbohydrate metabolism and synthesis, and neurobehavioral alterations in adulthood, in particular, social and cognitive deficits. Gut dysbiosis is increasingly being recognized as a key driver of a myriad of diseases, ranging from metabolic, cardiovascular, reproductive, and neurobehavioral disorders via the gut-microbiome-brain axis. Thus, EDCs might induce indirect effects on physical and mental health by acting as microbiome-disrupting chemicals. Findings raise the important question as to whether pregnant women should consume a probiotic supplement to mitigate pernicious effects of EDCs, especially BPA, on themselves and their unborn offspring. Current studies investigating the effects of maternal probiotic supplementation on pregnant women's health and that of their unborn offspring will be reviewed. Data will inform on the potential application of probiotic supplementation to reverse harmful effects of EDCs, especially BPA, in pregnant women unwittingly exposed to these compounds and striving to give their offspring the best start in life.

Development of an outcome indicator framework for a universal health visiting programme using routinely collected data

BackgroundUniversal health visiting has been a cornerstone of preventative healthcare for children in the United Kingdom (UK) for over 100 years. In 2016, Scotland introduced a new Universal Health Visiting Pathway (UHVP), involving a greater number of contacts with a particular emphasis on the first year, visits within the home setting, and rigorous developmental assessment conducted by a qualified Health Visitor. To evaluate the UHVP, an outcome indicator framework was developed using routine administrative data. This paper sets out the development of these indicators.MethodsA logic model was produced with stakeholders to define the group of outcomes, before further refining and aligning of the measures through discussions with stakeholders and inspection of data. Power calculations were carried out and initial data described for the chosen indicators.ResultsEighteen indicators were selected across eight outcome areas: parental smoking, breastfeeding, immunisations, dental health, developmental concerns, obesity, accidents and injuries, and child protection interventions. Data quality was mixed. Coverage of reviews was high; over 90% of children received key reviews. Individual item completion was more variable: 92.2% had breastfeeding data at 6–8 weeks, whilst 63.2% had BMI recorded at 27–30 months. Prevalence also varied greatly, from 1.3% of children’s names being on the Child Protection register for over six months by age three, to 93.6% having received all immunisations by age two.ConclusionsHome visiting services play a key role in ensuring children and families have the right support to enable the best start in life. As these programmes evolve, it is crucial to understand whether changes lead to improvements in child outcomes. This paper describes a set of indicators using routinely-collected data, lessening additional burden on participants, and reducing response bias which may be apparent in other forms of evaluation. Further research is needed to explore the transferability of this indicator framework to other settings.

This needs to be a journey that we’re actually on together’—the introduction of integrated care systems for children and young people in England: a qualitative study of the views of local system stakeholders during winter 2021/22

BackgroundIntegrated care has become a central feature of health system reform worldwide. In England, Integrated Care Systems (ICS) are intended to improve integration across public health, the National Health Service (NHS), education and social care. By April 2021, England had been divided into 42 geographical areas, each tasked with developing local ICS provision. However, it was not clear how ICSs would address the specific needs of children and young people (CYP). This study elicited the views of senior professional stakeholders in the first year of the ICS national roll out, to learn how integrated care for CYP was being implemented within the ICSs and future plans for service provision.MethodsA qualitative analysis of in-depth interviews with stakeholders, including healthcare professionals, NHS managers and local authority leaders (n = 25) selected from a diverse sample of ICSs (n = 7) across England, conducted during winter 2021/22. Reflexive thematic analysis involving a collaborative coding approach was used to analyse interview transcripts.ResultsFour themes were identified, indicating challenges and opportunities for ICSs in relation to the health of CYP: 1) Best start in life (a more holistic approach to health afforded by integrated care); 2) Local and national contexts (tensions between local and national settings and priorities); 3) Funding and planning (instituting innovative, long-term plans using limited existing CYP funding streams); 4) Organisational complexities (integrating the work of diverse organisations).ConclusionsThe views of stakeholders, provided at the beginning of the journey towards developing local ICS CYP provision, revealed a common aspiration to change focus from provision of acute, largely adult-orientated services towards one with a broader, population health remit, including prevention and early intervention. This would be delivered by integration of a range of local services, including health, education, housing and social care, to set CYP on a life-long path towards improved health and wellbeing. Yet there was an awareness that change would take place over time within existing national policy and funding frameworks, and would require overcoming organisational barriers through further developing local collaborations and partnerships. As ICSs mature, the experiences of stakeholders should continue to be canvassed to identify practical lessons for successful CYP integrated care.

Exploring Ofsted's ‘Best start in life’ report, part two

Ofsted recently published the second in a series of three research reviews, entitled the ‘Best start in life’, and focused on the early years curriculum. The reviews run alongside a series of curriculum research reviews published by the inspectorate for the National Curriculum subjects. This second early years review focuses on the prime areas within the Statutory Framework. Sue Cowley explains more.

Evaluation of the Healthy Start voucher scheme on maternal vitamin use and child breastfeeding: a natural experiment using data linkage.

Having a good start in life during pregnancy and infancy has been shown to be important for living both a healthy life and a longer life. Despite the introduction of many policies for the early-years age group, including voucher schemes, with the aim of improving nutrition, there is limited evidence of their impact on health. To assess the effectiveness of the Healthy Start voucher scheme on infant, child and maternal outcomes, and to capture the lived experiences of the Healthy Start voucher scheme for low-income women. This was a natural experiment study using existing data sets, linked to routinely collected health data sets, with a nested qualitative study of low-income women and an assessment of the health economics. Representative sample of Scottish children and UK children. Growing Up in Scotland cohort 2 (n = 2240), respondents to the 2015 Infant Feeding Study (n = 8067) and a sample of 40 participants in the qualitative study. The Health Start voucher, a means-tested scheme that provides vouchers worth £3.10 per week to spend on liquid milk, formula milk, fruit and vegetables. Infant and child outcomes - breastfeeding initiation and duration; maternal outcomes - vitamin use pre and during pregnancy. The exposed group were women receiving the Healthy Start voucher (R), with two control groups: eligible and not claiming the Healthy Start voucher (E) and nearly eligible. There was no difference in vitamin use during pregnancy for either comparison (receiving the Healthy Start voucher, 82%; eligible and not claiming the Healthy Start voucher, 86%; p = 0.10 vs. receiving the Healthy Start voucher, 87%; nearly eligible, 88%; p = 0.43) in the Growing Up in Scotland cohort. Proportions were similar for the Infant Feeding Study cohort (receiving the Healthy Start voucher, 89%; eligible and not claiming the Healthy Start voucher, 86%; p = 0.01 vs. receiving the Healthy Start voucher, 89%; nearly eligible, 87%; p = 0.01); although results were statistically significantly different, these were small effect sizes. There was no difference for either comparison in breastfeeding initiation or breastfeeding duration in months in Growing Up in Scotland, but there was a negative effect of the Healthy Start voucher in the Infant Feeding Survey. This contrast between data sets indicates that results are inconclusive for breastfeeding. The qualitative study found that despite the low monetary value the women valued the Healthy Start voucher scheme. However, the broader lives of low-income women are crucial to understand the constraints to offer a healthy diet. Owing to the policy being in place, it was difficult to identify appropriate control groups using existing data sources, especially in the Infant Feeding Study. As the Healthy Start voucher scheme attempts to influence health behaviour, this evaluation can inform other policies aiming to change behaviour and use voucher incentives. The null effect of Healthy Start vouchers on the primary outcomes may be due to the value of the vouchers being insufficient to change the broader lives of low-income women to offer a healthy diet. The methods developed to undertake an economic evaluation alongside a natural experiment using existing data can be used to explore the cost-effectiveness of the Healthy Start voucher scheme. This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 11, No. 11. See the NIHR Journals Library website for further project information.

The Dutch Solid Start program: describing the implementation and experiences of the program's first thousand days

BackgroundIn 2018, the Dutch government initiated the Solid Start program to provide each child the best start in life. The program focuses on the crucial first thousand days of life, which span from preconception to a child’s second birthday, and has a specific focus towards (future) parents and young children in vulnerable situations. A key program element is improving collaboration between the medical and social sector by creating Solid Start coalitions. This study aimed to describe the implementation of the Dutch Solid Start program, in order to learn for future practice and policy. Specifically, this paper describes to what extent Solid Start is implemented within municipalities and outlines stakeholders’ experiences with the implementation of Solid Start and the associated cross-sectoral collaboration.MethodsQuantitative and qualitative data were collected from 2019 until 2021. Questionnaires were sent to all 352 Dutch municipalities and analyzed using descriptive statistics. Qualitative data were obtained through focus group discussions(n = 6) and semi-structured interviews(n = 19) with representatives of care and support organizations, knowledge institutes and professional associations, Solid Start project leaders, advisors, municipal officials, researchers, clients and experts-by-experience. Qualitative data were analyzed using the Rainbow Model of Integrated Care.ResultsFindings indicated progress in the development of Solid Start coalitions(n = 40 in 2019, n = 140 in 2021), and an increase in cross-sectoral collaboration. According to the stakeholders, initiating Solid Start increased the sense of urgency concerning the importance of the first thousand days and stimulated professionals from various backgrounds to get to know each other, resulting in more collaborative agreements on cross-sectoral care provision. Important elements mentioned for effective collaboration within coalitions were an active coordinator as driving force, and a shared societal goal. However, stakeholders experienced that Solid Start is not yet fully incorporated into all professionals’ everyday practice. Most common barriers for collaboration related to systemic integration at macro-level, including limited resources and collaboration-inhibiting regulations. Stakeholders emphasized the importance of ensuring Solid Start and mentioned various needs, including sustainable funding, supportive regulations, responsiveness to stakeholders’ needs, ongoing knowledge development, and client involvement.ConclusionSolid Start, as a national program with strong local focus, has led to various incremental changes that supported cross-sectoral collaboration to improve care during the first thousand days, without major transformations of systemic structures. However, to ensure the program’s sustainability, needs such as sustainable funding should be addressed.

Public health prevention in maternity programme: supporting the local system

Too many children in the North East and North Cumbria Integrated Care System do not have the best start in life, and maternity care offers an early opportunity to initiate positive change. In 2018, a new model of regional public health leadership was developed to complement the developing local maternity system with a focus on prevention and reducing health inequalities. With the support of local maternity system partners, the programme set out to improve the quality of preventative intervention available to women and their families in the perinatal period. The programme focused on tobacco, alcohol, breastfeeding, reproductive health, perinatal mental health, healthy weight, immunisations and making every contact count. Through audit and co-production of regional pathways, it increased awareness, enabled greater consistency of service provision and supported quality improvement. As part of a large, evolving health and care system, the programme worked through significant challenges, such as complex leadership and governance models, prioritisation and ensuring that resources supported practice development across all local maternity services in the North East and North Cumbria Integrated Care System. Greater progress was made in areas such as reducing maternal smoking and increasing rates of breastfeeding, reflecting the critical role of local leadership. There is clear evidence of the programme's value to the local system. Ongoing evaluation and work to embed a sustainable model of delivery remain important.

Extent and nature of poverty in Australia and the impact on rural health

The Senate Standing Committee on Community Affairs is conducting an Inquiry into the extent and nature of poverty in Australia.1 The National Rural Health Alliance (the Alliance) made a submission to this Inquiry in February 2023, with findings expected in October 2023.2 The Alliance believes that all Australians, wherever they live, should have access to comprehensive, accessible and high-quality health, disability and aged care, as well as other social assistance services. The Alliance does not consider that poor access to services, suffering ill health or premature death should be accepted outcomes of living in rural Australia. The Alliance highlights the multidirectional inter-relatedness of health, education and poverty and explores these concepts in further detail in its submission to the Senate Inquiry. Reducing poverty is good for health outcomes as well as social and economic outcomes. Investing in actions to address poverty, and other determinants of health, is an investment in human capital and is central to health and well-being in rural Australia, as are measures that ensure universal access to health care for those who experience inequity. Universal and structural social service approaches to reducing economic inequality are also essential to addressing poverty and health inequity. Due to the inter-relatedness of poverty and ill health, such approaches must work alongside co-designed and tailored solutions that are adaptable and flexible and build upon strengths and capabilities in local communities. This is especially critical in rural areas where there are thin or failed markets and services or support are lacking. Rural areas are not mini-metropolitan areas where a city solution can be ‘helicoptered in’ to solve a specific rural problem (no matter how well-intended). Tailored measures are likely to be more accepted and embraced by residents, especially if they are co-designed and inclusive of diversity within the community and when shared ownership can help drive the outcomes. The disparities also extend to research in rural Australia. Poverty is relative. It involves people experiencing deprivation and making difficult life decisions about necessities (for example, choosing to use limited finances to pay for meals or medications, but not both). The affordability of food, groceries, energy, housing, fuel or transport and other essentials (including medicines, out-of-pocket health costs) plays an important role in these decisions. Access to high-quality, affordable health care, regardless of where you live, is important to reducing poverty and improving the health, well-being and broader social and economic goals of rural communities. The Grattan Institute has noted that poorer people are not getting the GP services they need, with disadvantaged Australians facing barriers to care. Furthermore, there are even higher access barriers for allied health services. Compared with GP care, allied health services have higher average out-of-pocket charges and make up a bigger share of household spending on health.9 This is without considering barriers related to workforce shortages and long wait times in rural areas. The National Preventive Health Strategy 2021–2030† provides direction for preventive health action across the course of life. It also presents an opportunity to build sustainable systems, address increasing burden of disease and reduce health inequities, as well as improve preparedness for emerging health threats.10 Preventive health actions can build on strengths and mitigate risks. The focus on providing the best start in life and across the life course, and its potential to influence actions outside the health sector given the crossover in risks and protective factors, can provide a focus for community co-design. These principles align with the Primary care Rural Integrated Multidisciplinary Health Services (PRIM-HS) model proposed by the Alliance as a solution for providing primary care services in rural areas where the market is failing or has failed.‡ While the causes of poverty are complex, as are the multifaceted responses required, the Alliance argues that improving access to health care and supporting the healthcare workforce in rural Australia will lead to significant improvements in health and well-being and lower the rate of poverty experienced. This will, of course, advantage not only rural Australians but all who benefit from the food supply, exports and gross domestic product (GDP) supplied by the 30 per cent of the population who live outside metropolitan centres. Margaret Deerain: Writing – review and editing; writing – original draft.

Nurturing children's development through healthy eating and active living: Time for policies to support effective interventions in the context of responsive emotional support and early learning.

Fostering the growth, development, health, and wellbeing of children is a global priority. The early childhood period presents a critical window to influence lifelong trajectories, however urgent multisectoral action is needed to ensure that families are adequately supported to nurture their children's growth and development. With a shared vision to give every child the best start in life, thus helping them reach their full developmental potential, we have formed the International Healthy Eating Active Living Matters (HEALing Matters) Alliance. Together, we form a global network of academics and practitioners working across child health and development, and who are dedicated to improving health equity for children and their families. Our goal is to ensure that all families are free from structural inequality and oppression and are empowered to nurture their children's growth and development through healthy eating and physical activity within the context of responsive emotional support, safety and security, and opportunities for early learning. To date, there have been disparate approaches to promoting these objectives across the health, community service, and education sectors. The crucial importance of our collective work is to bring these priorities for early childhood together through multisectoral interventions, and in so doing tackle head on siloed approaches. In this Policy paper, we draw upon extensive research and call for collective action to promote equity and foster positive developmental trajectories for all children. We call for the delivery of evidence-based programs, policies, and services that are co-designed to meet the needs of all children and families and address structural and systemic inequalities. Moving beyond the "what" is needed to foster the best start to life for all children, we provide recommendations of "how" we can do this. Such collective impact will facilitate intergenerational progression that builds human capital in future generations.

Monitoring the Dutch Solid Start Program: Developing an Indicator Set for Municipalities to Monitor their First Thousand Days-Approach.

The Dutch Solid Start program aims to improve the collaboration between the medical and social sector to offer every child the best start in life. Municipalities form local coalitions of partners within the medical and social sector to support parents and children during the first thousand days. The aim of this study was to develop an indicator set for coalitions to monitor their local Solid Start program. A modified Delphi study with three rounds was carried out among Dutch experts in Solid Start practice, policy and research (n = 39) to reach consensus. The indicator set included 19 indicators covering the three phases of the Solid Start program: preconception, pregnancy and after birth (up to two years). Prioritized indicators included both social and medical topics, among which poverty, psychological/psychiatric problems, stress, smoking, cumulation of risk factors, preconception care, low literacy, premature birth, and intellectual disability. Additionally, a development agenda was established with topics and indicators that lacked data or clear operationalization (e.g. stress, unintended pregnancy, loneliness). The developed indicator set enhances the conversation between policymakers, managers, professionals and other stakeholders about the local situation and developments in order to prioritize interventions and policies. Next, the indicator set needs evaluation to assess its usefulness.

How involved are parents in their child's early years setting's food decisions and practices?

As childhood obesity and poor nutrition rates in England continue to rise, parents and childcare practitioners have key partnership roles in ensuring young children have healthy balanced diets. Yet little is known about parents' understanding and involvement in their childcare settings' food decisions and practices, and how this might be strengthened. Semi-structured interviews were carried out with a purposive sample of 59 parents with one or more children attending early years settings in England. Framework analysis was used to explore the interviews. Epstein's model of parental partnerships was adapted as a reflective lens for the findings, and their implication for early years' policy and practice. Parents reported a lack of two-way communication on food, and of opportunities for active, meaningful engagement around food and healthy eating outside of one-to-one discussions of their child's specific needs and requirements. Some parents reported a lack of trust in the food related information provided by their childcare setting. As young children spend more time in formal childcare, it is increasingly important that trusting collaborative relationships are built between parents and childcare practitioners to ensure that children have the best start in life. This study adds to the limited literature on parental involvement in early years settings. Findings suggest that more policy work and development is needed in the early years sector, particularly in ensuring clear and accessible guidelines on food in early years settings are readily available, and that practitioners and parents have more clarity about their mutual roles and responsibilities in this.

A Good start in life: Effectiveness of integrated multicomponent multisector support on early child development-Study protocol.

IntroductionEarly childhood experiences have a lifelong impact on a child’s future. Social and environmental experiences and interactions have a profound relational effect on children’s physical and mental health which transfers agency to parents, caregivers and duty-bearers to care for the child’s welfare. In the Australian context early child development indices have been in decline in some communities. Hence, there is a sense of urgency to reverse these trends from an integrated perspective. A multisector, multi component program of interventions named A Good Start in Life is proposed and is being tested in the Australian Capital Territory across suburbs with high levels of early childhood development disadvantage. The aim of this study is to evaluate the outcomes and processes related to targeted interventions, designed to integrate child and family services within the local district and embed allied health programs into early childhood education, care services and playgroups.Methods and analysisThe Good Start in Life study will use a quasi-experimental design (with a matched control geographical area) consisting of a combination of interventions that will build multisectoral collaboration across education, health and social services that connect and support families with children from birth to 5 years. The control area will be matched on demographic characteristics and early child development outcomes and trends over the pre-intervention period. Evaluation data will be collected at baseline, and then on an annual basis for a further three years. A mixed methods approach will be used to evaluate delivery processes: quantitative (checklists, questionnaires) and qualitative methods (observations, focus groups and key stakeholder interviews). Effectiveness of the programme will be evaluated by comparing early child development outcomes between the comparator areas from the Australian Early Development Census in 2024. The primary focus will be on reducing the number of children who are developmentally vulnerable on at least one early development index (EDI). Separate tests will be conducted for significant differences in the percentage of children at risk in each of the five individual EDI domains. These domains are physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, and communication and general knowledge.Trial registrationACTRN12621001140842.

Birthing on Country for the best start in life: returning childbirth services to Yolŋu mothers, babies and communities in North East Arnhem, Northern Territory.

Birthing on Country for the best start in life: returning childbirth services to Yolŋu mothers, babies and communities in North East Arnhem, Northern Territory.

Playing out

The movement for child-friendly cities and neighbourhoods is gaining momentum across the UK and abroad. Nicole Weinstein finds out how thoughtful urban planning and design can play a major role in giving children a good start in life

‘What works’ and for whom? Bold Beginnings and the construction of the school ready child

School readiness is a dominant discourse in current policy agendas in UK and international contexts, fulfilling a range of goals such as providing children with the ‘best start in life’ by breaking the cycle of poverty, and preparing children for formal learning in compulsory education. Focussing on the school readiness agenda in England, this paper interrogates how the local touchdown of international policy formulations influences policy at country-level. It is argued that the emphasis on teaching Mathematics, Reading and Writing as a way of readying children for school raises concerns over the formalisation of pedagogy and curriculum in the Reception year (aged 4–5), in preparation for the transition to Year One of the National Curriculum. Using Hyatt’s Critical Discourse Policy Analysis Frame (CPDAF) this paper examines how the Office for Standards in Education (OfSTED) report ‘Bold Beginnings’ further strengthens the policy discourse that establishes Reception as a site for school readiness through a discursively constructed narrative of ‘what works’. Based on the analysis, the paper then questions whether the ‘what works’ OfSTED agenda works for teachers and children.

A qualitative exploration of postpartum care uptake among vulnerable women

Introduction Postpartum care can help provide a good start in life for newborns and their families. In the Netherlands, every woman qualifies for eight consecutive days of postpartum care at home. Maternity care assistants (MCAs), supervised by midwives, provide supportive care focused on coping with the new situation and increasing parents’ confidence. As vulnerable women generally use less postpartum care, we aimed to gain insight into their postpartum care uptake process including perceived barriers and facilitators.MethodsWe conducted a qualitative semi-structured interview study among vulnerable women. Vulnerable women, as determined by their healthcare professional, were asked to participate from third trimester until 12 weeks postpartum. Purposive sampling was applied to include 23 participants (sixteen postpartum and seven pregnant women). All interviews were audio-taped and transcribed verbatim. The data was analyzed using a Grounded Theory approach.ResultsPostpartum care uptake among vulnerable women was experienced as a process of chronological phases during the perinatal period, which included four stages: expectations, decisions, experiences, and evaluations regarding (the uptake of) postpartum care. Within these stages three main themes were identified that may act as facilitators or barriers in transition between stages: information provision, a woman’s self-efficacy, and her social network.Information provision on content of care was perceived as essential but was often insufficient, thus acting as a barrier to postpartum care uptake. All women stated that postpartum care enhanced their self-efficacy. Low self-efficacy prior to postpartum care led to high expectations and evaluations, while negatively influencing their ability to make decisions regarding care uptake.Vulnerable women differed with respect to their social network. Absence of a social network facilitated positive expectations, experiences and evaluations of postpartum care but negatively influenced informed decisions. An extensive social network facilitated negative and positive expectations prior to postpartum care, while it also acted as a barrier to care uptake. Discussion and conclusionsThe generated conceptual framework shows the uptake of postpartum care among vulnerable women is a complex process influenced by potential barriers and facilitators in different stadia of the care process. To improve the benefits of postpartum care, it is essential to consider the particular stage and relevant themes applying to individual women and adapt care accordingly. As the experienced insufficient information provision may be grounded in health illiteracy, providing adequate and comprehensible information combined with enhancing self-efficacy is advocated.Lessons learned• Healthcare professionals including MCAs should provide adequate and comprehensible information on postpartum care to reduce the influence of vulnerable women’s unfamiliarity regarding content of care. • Optimization of information provision, enhancing self-efficacy, and insight in vulnerable women’s social networks may be beneficial in order to tailor care to the specific situation and needs of individual women.Limitations Our qualitative study identified barriers and facilitators to postpartum care uptake perceived by vulnerable women. As these depend on their perception, they may not accurately reflect the whole spectrum of barriers and facilitators.Suggestions for future research The proposed framework should be tested in an intervention study among a broader population of vulnerable women.

A Quality Improvement Initiative: Improving First-hour Breastfeeding Initiation Rate among Healthy Newborns.

Introduction:“No matter where a newborn takes his or her first breath, the desire to give that baby the best start in life is universal.” The best gift a mother can give her baby is the gift of health. The gift of health can be given to the baby through early and adequate breastfeeding. Globally, only 2 out of 5 newborns are put to the breast within the first hour of life. Therefore, initiating breastfeeding is an evidence-based intervention for improving neonatal survival.Methods:We aimed to improve the first-hour breastfeeding initiation rate from the existing 12%–80% over 3 months through a quality improvement (QI) process. The setting was antenatal, perinatal, and postnatal wards of the Maharishi Markandeshwar Institute of Medical Sciences And Research Hospital. The participants were postpartum mothers with stable newborns 35 weeks and older of gestation born by normal vaginal delivery.Procedure for QI:A team of nurses and obstetricians was formed; we analyzed possible reasons for delayed initiation of breastfeeding by process cycle matrix chart and Fishbone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act cycles. The outcome measure is the proportion of eligible babies breastfed within 1 hour of delivery.Results:After 3 months, the first-hour initiation of breastfeeding increased from 12% to 80%, without additional resources.Conclusions:A QI approach achieved an improvement in first-hour breastfeeding rates after normal vaginal delivery.

It takes a whole village?

It takes a whole village?

Sytuacja polityczno-gospodarcza w Republice Południowej Afryki i jej wpływ na imigrację

Migration processes have accompanied man since the dawn of time. In the case of migration currents to South Africa after World War II, there are several factors influencing the decisions to migrate. There were several waves of migration, depending on the changing in the second half of the Twentieth century South Africa’s economic and political situation. To properly present the issue of migration to South Africa, both from Poland and other countries of the world, it is first necessary to focus on the events that enabled the development of a policy of racial segregation. Then focus on economic development during this period that determined the successive waves of migrants. The last, crucial element is focusing on emigrants and the reasons for their emigration. In the case of the Polish diaspora in South Africa, many people decided to leave Poland due to the political system that was in the communist period; they wanted to give their children a better start in life or simply wanted to develop professionally, which was not possible at that time in the country. The aim of this article is to present the political, economic, demographic and social factors that influenced migration to South Africa.