Health Visitor Intervention Research Articles

Timeliness and equity of infant pertussis vaccination in wales: Analysis of the three dose primary course

Infants aged under one year are at the highest risk of severe complications or death from pertussis infection. Prompt vaccination with a three dose course at two, three and four months of age decreases the amount of time they are vulnerable following waning of maternal antibodies. In Wales, uptake of all three doses of the primary course of pertussis containing vaccine is high. However, timeliness and equity at a population level have not been previously reported.This analysis included 163,733 children born from 1st January 2013 to 31st December 2017. In this cohort 87.9% received the first dose of a pertussis containing vaccine by 12 weeks of age, 87.1% had received all three doses by 24 weeks of age, and 96.3% received three doses by 52 weeks of age.Differences in uptake between those living in the most deprived and least deprived quintiles of Lower Super Output Area (LSOA) were smaller than differences in timeliness, but statistically significant. In 2017 the difference in timely uptake between those living in the most and least deprived quintiles was 4%, 5% and 7% for doses one, two and three respectively. There was a difference of 10% in the proportion of infants receiving all three primary vaccinations on time between the most and least deprived quintile of LSOAs.Consideration is needed on interventions that will help improve timeliness such as enhanced follow up of defaulters, electronic communication between primary care data systems, enhanced health visitor intervention and opportunistic vaccination in those who fail to attend scheduled vaccination appointments. There is also the need for routine monitoring of timeliness and further research into what influences delayed vaccination.

Training health visitors in cognitive behavioural and person-centred approaches for depression in postnatal women as part of a cluster randomised trial and economic evaluation in primary care: the PoNDER trial

This paper aims to describe the training preparation for health visitors who took part in the intervention arm of a cluster randomised controlled trial and economic evaluation of training for health visitors - the POstNatal Depression Economic evaluation and Randomised (the PoNDER) trial. A secondary aim is to make available, by electronic links, the training manuals developed for and used for the cognitive behavioural approach (CBA) and the person-centred approach (PCA) training for the health visitors. The paper is of relevance to health visitors, general practitioners, nurse practitioners, midwives, clinical psychologists, mental health nurses, community psychiatric nurses, counsellors, and service commissioners. The trial clinical outcomes have been published, indicating the pragmatic effectiveness of the package of training for health visitors to identify depressive symptoms and provide a psychologically informed intervention. The training was associated with a reduction in depressive symptoms at six months postnatally among intervention group women and some evidence of a benefit for the intervention group for some of the secondary outcomes at 18 months follow-up. The two experimental interventions examined in the PoNDER trial built upon promising work on the potential for psychological interventions to help women recover from postnatal depression as an alternative to pharmaceutical interventions and to address the limitations of previous research in the area. The package of health visitor training comprised the development of clinical skills in assessing postnatal women and identifying depressive symptoms, and the delivery of a CBA or a PCA for eligible women. This was the largest trial a health visitor intervention and of postnatal depression ever conducted. We are aware of no other rigorously performed trial that has published details of an extensively tested training programme for the benefit of health-care professionals and clients.

Can health visitor intervention change sun safety policies and practice in preschool establishments? A randomised controlled study

Objective In the UK there have been no initiatives identified to increase the use of sun safety policies in preschool establishments. This study tests the hypothesis that health visitors with appropriate sun safety training can successfully facilitate the development and implementation of sun safety policies and practices in preschool education and care establishments. Design A two-stage randomised controlled study. Setting All providers of preschool care or education situated within the boundaries of North Derbyshire Health Authority ( n=198). Method In stage one an initial postal screening survey of all preschool providers was conducted to determine the extent to which their policies and practices were consistent with ideal practice for sun safety. Providers who did not have a written sun safety policy were invited to participate in stage two of the study in which they were randomly assigned to either intervention group or control group. The intervention establishments received visits over a four-month period from a health visitor who had attended a one-day sun safety training event. Results The overall response rate to the initial screening survey was 67 per cent ( n=133) of which 90 per cent did not have a written sun safety policy ( n=96). In the intervention group ( n=33) 88 per cent ( n= 29) of playgroups and nurseries had changed their sun safety practice by developing and implementing a sun safety policy, following visits from a health visitor. For example, the percentage of children wearing sun hats was associated with policy development ( r=0.4, p<0.05). In the control group ( n=41) no changes had been made to sun safety policy or practice. Conclusion This is an important finding for Primary Care Trusts who are charged with the development of the public health capacity of health visitors.

Older people in accident and emergency departments.

Older people attend accident and emergency departments more frequently than younger people. However, most assessments indicate that this higher level of use is appropriate and is the result of more serious injury and illness among this population. Older patients discharged from accident and emergency departments are frequently functionally impaired with serious impacts upon their ability to perform activities of daily living. Despite this, relatively little attention has been paid to interventions to improve older patients' ability to self-care after discharge from accident and emergency departments. One study has suggested that dependency can be reduced by health visitor intervention. Targeted bi-disciplinary interventions have been demonstrated to reduce the risk of recurrent falls in elderly patients discharged from accident and emergency departments.

Bowlby's attachment theory: implications for health visiting.

This article reviews the current state of research in attachment theory. It also examines the relations between attachment, child care and development, and the significance of attachment to adult functioning and well-being. It seems likely that humans need close emotional relationships or bonds with others. This need applies particularly to infants, who look to parents or other care givers for love and security. The best-known psychological explanation of this need is attachment theory, which has been influential in increasing our understanding of the early mother-infant relationship, and in the formulation of guidelines for child care (Melhuish, 1998). Good-quality parental care may be difficult to define, and questions remain regarding the nature of child care and the consequences that it can have for later development. This article concludes with a discussion of the possible implications for health-visitor intervention within families, which are intended to improve the quality of the relationship between parents or care givers and the infant.

A randomised controlled trial of specialist health visitor intervention for failure to thrive

A randomised controlled trial of specialist health visitor intervention for failure to thrive

A randomised controlled trial of specialist health visitor intervention for failure to thrive Commentary

To determine whether home intervention by a specialist health visitor affects the outcome of children with failure to thrive. Children referred for failure to thrive were randomised to receive conventional care, or conventional care and additional specialist home visiting for 12 months. Outcomes measured were growth, diet, use of health care resources, and Bayley, HAD (hospital anxiety and depression), and behavioural scales. Eighty three children, aged 4-30 months, were enrolled, 42 received specialist health visitor intervention. Children in both groups showed good weight gain (mean (SD) increase in weight SD score for the specialist health visitor intervention group 0.59 (0.63) v 0.42 (0.62) for the control group). Children < 12 months in the intervention group showed a higher mean (SD) increase in weight SD score than the control group (0.82 (0.86) v 0.42 (0.79)). Both groups improved in developmental score and energy intake. No significant differences were found for the primary outcome measures, but controls had significantly more dietary referrals, social service involvement, and hospital admissions, and were less compliant with appointments. The study failed to show that specialist health visitor intervention conferred additional benefits for the child. However, the specialist health visitor did provide a more coordinated approach, with significant savings in terms of health service use. Problems inherent to health service research are discussed.

Effect of community based management in failure to thrive: randomised controlled trial

Objective : To evaluate the effectiveness of a health visitor led intervention for failure to thrive in children under 2 years old.Design : Controlled trial, randomised by primary care practice.Setting...

Emotional abuse treatment and prevention, a specialist health visitor's intervention

Child Abuse ReviewVolume 7, Issue 1 p. 58-62 Case Study Emotional abuse treatment and prevention, a specialist health visitor's intervention Patricia Hancock, Corresponding Author Patricia Hancock Child Protection, Kidderminster Health Care TrustChild Protection, Kidderminster Health Centre, Bromsgrove Street, Kidderminster, Worcs DY10 1PG, UKSearch for more papers by this author Patricia Hancock, Corresponding Author Patricia Hancock Child Protection, Kidderminster Health Care TrustChild Protection, Kidderminster Health Centre, Bromsgrove Street, Kidderminster, Worcs DY10 1PG, UKSearch for more papers by this author First published: 04 December 1998 https://doi.org/10.1002/(SICI)1099-0852(199801/02)7:1<58::AID-CAR359>3.0.CO;2-EAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume7, Issue1January/February 1998Pages 58-62 RelatedInformation

Health visitor intervention to reduce days of unplanned hospital re-admission in patients recently discharged from geriatric wards: the results of a randomised controlled study

A randomised controlled trial was conducted to assess whether a single intervention by a health visitor reduced the unplanned re-admission of elderly people discharged from geriatric wards. Two hundred and four consecutive discharges from geriatric wards were randomly allocated to receive either a single visit from the health visitor at 72 h in addition to normal follow-up services or to a control group receiving the normal follow-up services. The primary outcome measure was the unplanned re-admissions over the following 6 months. There were 40 cases and 43 control patients with unplanned re-admissions in the first 6 months. The total lengths of the unplanned re-admissions were 1237 days for cases and 1427 for controls, an average of 12.1 days for cases and 14.0 for controls (95% confidence interval −4.9 to 8.7 days, not significant). A visit by a health visitor to elderly patients after discharge from geriatric wards is unlikely to be of sufficient benefit to the patients for the service to be funded from a saving in unplanned re-admissions.

A Randomised Controlled Trial of Health Visitor Intervention on Unplanned Readmission of Elderly Patients After Hospital Discharge

A Randomised Controlled Trial of Health Visitor Intervention on Unplanned Readmission of Elderly Patients After Hospital Discharge

Health visiting: Action research in a controlled environment

The nature of health visiting is discussed. It operates in a radically different way from any of the curative services. Research into the effectiveness of health visiting must therefore take into account the many differences in context, in professional goals and in the nature of the interaction between health visitors and their “clients”, compared with the work of the curative professions within their more controlled and controlling environments. The evaluation of one large scale health visitor intervention study is used here to highlight these differences. Health visiting research needs to free itself from the attempts by some to apply the laboratory model of evaluation, if it is to develop a corpus of “action research” thinking which reflects its more human and developmental characteristics.

Counselling in a general practice setting: controlled study of health visitor intervention in treatment of postnatal depression.

To determine whether counselling by health visitors is helpful in managing postnatal depression. Controlled, random order trial. Health centres in Edinburgh and Livingston. Sixty women identified as depressed by screening at six weeks post partum and by psychiatric interview at about 13 weeks post partum. Five women did not wish to participate, and a further five did not complete the trial. Age, social and obstetric factors, and diagnosis were similar in women who completed the trial and those who withdrew. Eight weekly counselling visits by health visitors who had been given a short training in counselling for postnatal depression. Reduction of depression. MEASUREMENTS and main results--Standardised psychiatric interviews and a 10 point self report scale were used to identify depression before and after intervention. The psychiatrist was not told to which group women were allocated. After three months 18 (69%) of the 26 women in the treatment group had fully recovered compared with nine (38%) of the 24 in the control group. The difference between the groups was thus 32% (95% confidence interval 5 to 58). Counselling by health visitors is valuable in managing non-psychotic postnatal depression.

Hospitalized cases of nonorganic failure to thrive: The scope of the problem and short-term lay health visitor intervention

This paper describes the characteristics of thriving and failure to thrive (FIT) children and their mothers and examines the effect of short-term lay health visitor intervention in cases of nonorganic failure to thrive (NO FTT). Twenty-five FTT children and mothers received lay health visitor (LHV) intervention in addition to other community and medical treatment; 25 other FTT children and mothers did not receive the LHV intervention but did receive all other medical and community treatment. Twenty-five thriving children and mothers were matched with the FTT children and mothers in the LHV group on the child's age at intake, sex, birth weight, and the mother's age, ethnicity, and number of living children. At initial assessment, the FTT and thriving groups were found to be comparable on demographic factors, infant birth weight percentiles, apgar scores, complications of pregnancy or delivery, and separations in the newborn period. There were more premature births in the LHV group although the proportion of premature births for the FTT and thriving groups overall were similar. A majority of mothers in the FTT groups had negative memories of childhood in contrast to more positive memories in the thriving group. At initial assessment, the majority of thriving children were developmentally normal and had increased from their birth weight percentiles whereas all of the FTT children had decreased from their birthweight percentiles and over half were developmentally delayed. There were clear differences in mother-child interaction patterns in the thriving and FTT groups. Three patterns of interaction were identified in the FTT group: benign neglect, incoordination, and overt hostility. Intervention had no measurable effect on the child's weight, development, or interaction patterns. Only 8 of 37 FTT children reevaluated 6 months later showed “catch up” growth and only 7 had improved in developmental score category. Patterns of interaction were found to persist over the 6 months in all cases. One to three year follow-up of 44 families emphasized the severity of the condition and the need for differentiation of the severity of the disturbance in the mother-child relationship and for more intensive intervention than was available in this study. Of these 44 cases, 2 children had died, 5 had been physically abused or further neglected, and 10 were in alternative care arrangements.

Measuring life satisfaction in an elderly female population

The study described in this paper was undertaken as part of the pilot work for a main study, which attempts to evaluate the effectiveness of health visitor intervention on an elderly female population in Scotland. The Life Satisfaction Index A (Neugarten et al. 1961) was modified by the researcher and tested on a female Scottish population and is subsequently being used as one of three outcome measures of health visitor intervention.