Health Visitor Practice Research Articles

A qualitative study of health visitors' family focused practice with mothers with mental illness in Northern Ireland: Perspectives of health visitors, mothers and partners.

Despite benefits of family focused practice, little is known about health visitor's practice with families when mothers are mentally unwell. Health visitors are midwives and nurses with additional training in community public health. To explore multiple perspectives of health visitor's family focused practice with families when mothers have mental illness in Northern Ireland. Ten health visitors, 11 mothers with mental illness and seven partners completed in-depth interviews in Five Health and Social Care Trusts. Participants were asked to describe their experiences of providing or receiving family focused practice within health visiting and data was analysed using thematic analysis. Health visitors primarily addressed mothers and children's needs rather than also supporting partners. Additionally, they only addressed mother's needs associated with less severe mental illness (i.e. postnatal depression). Health visitors and mothers converged on many issues, including the influence of the health visitor's personal and professional experiences on their practice, central role of the relationship between health visitors and mothers and importance of health visitors supporting partner's well-being. While partners did not perceive that health visitors should support their well-being they expressed a need for further information and knowledge in order to support mothers. Health visitor's practice largely centres around mother and baby. For health visitors to increase their family focused practice they need to meet needs of mothers who have serious mental illness more effectively and consider how partners can be included in their practice, in a manner that is beneficial and acceptable to them. This study contributes to better understanding of health visitor's family focused practice with mentally ill mothers and highlights the need for more effective engagement with mothers with serious mental illness and partners. It also highlights that for health visitors to engage in family focused practice they need the necessary training and time to do so. Results can inform organisational developments in family focused practice within health visiting.

Paternal influences on children's school readiness

In recent decades, a societal shift in paternal parenting has influenced family health, wellbeing and child development, with modern fathers appearing to have greater caregiver responsibilities compared to previous generations. This article aims to explore the paternal influences of father–child relationships on school readiness. Ten studies were critically reviewed from the literature. The findings suggest that positive father–child play interactions influence child development. Warm, sensitive and supportive parenting was recognised to promote child development and facilitate school readiness. Health visitor practice was explored and it is concluded that effective public health approaches must be used to ensure father-inclusive practice so that children's school readiness can be facilitated.

Exploring the current practice of health visitors to assess and support paternal mental health

The importance of identifying and supporting paternal mental health during the perinatal period has been gathering momentum. Health visitors are ideally placed due to their contact with families to assess and support paternal mental health. The aim of this study was to explore health visitors' current practice to assess and support paternal mental health and identify any barriers preventing this in practice. A small-scale, anonymous electronic 12 question survey was conducted. Purposeful sampling method was used to recruit health visitors (n=120) from across three health visiting services provided by UK NHS Trust selected for this study. Survey response rate was low (n=36), limiting the potential to generalise findings to the wider health visiting population. Most respondents were discussing paternal mental health during contacts with families, and four main barriers impeding the assessment of paternal mental health were identified. Respondents identified that paternal mental health training would support their own practice.

A systematic review of practitioner enquiry into adverse childhood experiences in primary care

This article presents the findings of a systematic review undertaken to assess adverse childhood experiences (ACE) enquiry among practitioners of primary care for children's services. Literature was eligible for inclusion if it included the primary care practitioner experience of ACE enquiry, was published from 1998–2021 and was in English. The most frequently cited themes across all included studies were time and training, with time the most commonly cited barrier. The findings indicate that aspects of the health visitor service model include facilitators to integrate ACE enquiry into routine health visitor practice, although the research highlights barriers of time and resources. Further research is required to expand the limited evidence base for incorporating ACE enquiry into health visitor practice in the UK and to similar models of care internationally.

Transferring Knowledge on Motor Development to Socially Vulnerable Parents of Infants: The Practice of Health Visitors.

Parents are a determinant factor in a child’s development of motor skills. Studies show that programmes in which health visitors supervise parents may improve infants’ motor skills. This study examines which factors health visitors have found to enhance and hamper the implementation of a motor development programme among socially vulnerable parents of infants. The data consist of three group interviews with 4 health visitors in each (12 health visitors in total) and a subsequent member check with 27 health visitors. All were audio-recorded and transcribed verbatim, and a thematic analysis was conducted. The results show that according to the health visitors, the programme increases the ability and willingness of parents to engage in co-producing its implementation. In particular, the materials that they hand out to the parents enhance the implementation. On the other hand, they perceive the limited time provided for the implementation, together with the many pressing needs of the families, as hampering the implementation. Consequently, the study can inform future policies and programmes for frontline workers and socially vulnerable parents of infants.

Young children's sleep difficulties: Are mainstream research findings supported by more recent evidence?

A substantial body of evidence about how to support parents with their child's sleep difficulties has been published and this can inform the practice of health visitors and others who work with the families concerned. However, does more recently published research in this field support or question the findings of mainstream studies? This article will examine how some recent studies do support and develop earlier evidence, while others open new fields of research, or challenge official guidance in new ways.

Newly qualified health visitor: Working with families to support breastfeeding

Bethany Boddy explores the barriers to breastfeeding in the UK and how practitioners can promote breastfeeding within health visitor practice

Introducing ‘Lift the Lip’ into the routine practice of health visitors

A project to assess the feasibility and acceptability of incorporating Lift the Lip into the routine practice of health visitors in Wales.

Images of the child in Danish welfare work in health visiting and day-care

ABSTRACTThis empirical article investigates the underlying ideas and images of children and childhood in the practice of health visitors and preschool teachers. Theoretically the article is based on the interpretation that these ideas and images are essential to understand the governing of children, though that the ideas of the possible and available subject positions in society are considered to be powerful and productive. As a typology for differing ideas about children and childhood, the article uses the child images developed by Chris Jenks and further developed by Karen M Smith. Furthermore, the analysis draws on concepts of Michel Foucault and Nikolas Rose.The results are based on ethnographical fieldwork and interviews, and the article concludes that both an innocent and a responsible image of the child form the practice of the health visitors and preschool teachers. An innocent child image fills up most of the time, but when the health visitors and preschool teachers are seeking explicitly to intervene and influence the children, a responsible child image is clearly dominant.

Midwifery students in health visitor placements: the importance of student-mentor relationships

ObjectiveThe aim of this study was to explore midwifery students and health visitor practice mentors experiences of a health visiting placement for midwifery students, focusing on the student-mentor relationship. DesignInterview study SettingEast London, United Kingdom ParticipantsEighteen students and eighteen mentors were invited to take part in an interview. Ten midwifery students (55.5%) and fifteen health visitor practice mentors (83.3%) took part in interviews or provided information via email. Thematic analysis was used to analyse findings. FindingsThe main study finding was that students reported valuing practice mentors who took the time to get to know them, were welcoming and enthusiastic and planned their time in advance. The mentors in turn spoke highly of the students who were keen and enthusiastic about the placement, but noted that not all students had appeared interested. Key conclusionsThe findings from this small interview study show that taking time to make the students feel welcome was important to facilitate a student-mentor relationship. Another important factor in whether a student enjoyed their placement was the mentors’ advance planning.

Examining the social construction of surveillance: A critical issue for health visitors and public health nurses working with mothers and children.

To critically examine surveillance practices of health visitors (HV) in the UK and public health nurses (PHNs) in Canada. The practice and meaning of surveillance shifts and changes depending on the context and intent of relationships between mothers and HVs or PHNs. We present the context and practice of HVs in the UK and PHNs in Canada and provide a comprehensive literature review regarding surveillance of mothers within public health systems. We then present our critique of the meaning and practice of surveillance across different settings. Concepts from Foucault and discourse analysis are used to critically examine and discuss the meaning of surveillance. Surveillance is a complex concept that shifts meaning and is socially and institutionally constructed through relations of power. Healthcare providers need to understand the different meanings and practices associated with surveillance to effectively inform practice. Healthcare providers should be aware of how their positions of expert and privilege within healthcare systems affect relationships with mothers. A more comprehensive understanding of personal, social and institutional aspects of surveillance will provide opportunities to reflect upon and change practices that are supportive of mothers and their families.

Working in partnership: the application of shared decision-making to health visitor practice.

To explore the processes that support shared decision-making when health visitors and parents are creating plans to improve the well-being of babies and children. Worldwide, there is a focus on promoting children's well-being to enhance the population health. Within the United Kingdom, health visitors have a key responsibility for working in partnership with parents to support this agenda. Despite evidence that the application of 'shared decision-making' frameworks can increase patient participation, improve patient satisfaction and improve health outcomes, there is limited research linking shared decision-making with health visitor practice. A qualitative, descriptive study. The study was undertaken in two phases: in Phase 1, data were collected by audio recording two health visitor-parent decision-making conversations, in the absence of the researcher, where decisions around planning for a baby or child were being made as part of usual care, and then the participants' experiences were sought through individual questionnaires. In Phase 2, semistructured interviews were conducted with nine health visitors and nine parents in relation to their recent experiences of planning care. Evidence of supportive processes included having a shared understanding around the issue needing to be addressed; being able to identify interventions that were accessible for the family; engaging in decision-making through deep, meaningful conversations using sensitive and responsive approaches; and establishing positive relationships between health visitors and parents, significant others within the family and other professionals. Despite evidence of strong, trusting relationships between parents and health visitors, there were times when shared decision-making was unable to take place due to the absence of supportive processes. Health visitors are aware that planning interventions with parents can be complex. These findings indicate the value of using a shared decision-making framework to structure planning, as application of a framework identified the processes that support a collaborative approach in practice.

Insider perspectives: Qualitative insight from health visitor practice teachers and managers in 2012/13

This study was conducted to understand the impact of the Health Visitor Implementation Plan on practice in the South West of England from the perspective of practice teachers and managers. A qualitative approach was used; data from practice teachers and managers were collected via semistructured interviews and analysed using thematic analysis. Ten practice teachers and seven managers took part. Increased student numbers following the launch of the implementation plan influenced models of practice supervision, which practice teachers found challenging but also felt had unexpected benefits for the workforce. Managers recognised tensions between newly qualified practitioners and existing staff already providing services using more traditional models. The results reiterate the complex relationship between policy and practice and promote discussion around supervision models and the influence of newly qualified health visitors on the service delivery of the future.

Health visiting students' experience of practice: A personal tutor's observations

In her role as a personal tutor to health visiting students, Adelle Shaw-Flach identified key issues in the student experience in practice. In this article, she explores these issues in an attempt to stimulate debate around the subject of health visitor practice education.

A Study of How Health Visitors Exchange Knowledge in the Context of Organisational and Policy Change

This paper draws upon selected findings from a small scale qualitative study of the situated practice of health visitors. The study was carried out in a context of local organisational change, after the merger of two primary care trusts in the north of England, and emergence of national policy drivers positioning health visitors in a leadership role in the delivery of integrated services to children and families. The findings from four focus groups give grounded and context specific examples of the types of knowledge that health visitors value and ways in which they exchange knowledge and draw upon the distributed knowledge and expertise of others. The results are interpreted through the lenses of different discourses of knowledge and barriers to change are identified through an iteration between practice-based narrative and theoretical frameworks. These barriers include: dominance of linear and hierarchical transmission models of knowledge transfer rather than promotion of a knowledge sharing/creating culture; a devaluing of context specific and practice based knowledge in comparison to abstract knowledge; bureaucratisation of knowledge; defensive practices emerging from a perceived threat to professional identity; and limited tools and allocation of time for collaborative work within the profession and across professional boundaries. Recommendations and strategies to drive change and enable health visitors to take on leadership roles in multi skilled teams and a multi agency context are underpinned by the argument that what is needed in this context is a transformational model of knowledge exchange and co creation of knowledge that works with tensions between different discourses of knowledge and promotes collaborative dialogue and practice across professional and organisational boundaries.

Smoking cessation intervention with pregnant women and new parents: A survey of health visitors, midwives and practice nurses

A survey was undertaken to examine the attitudes, knowledge and practice of health visitors, midwives and practice nurses in relation to smoking cessation intervention with pregnant women and new parents. In total, 65 questionnaires were completed (52.42% return rate). Health visitors, midwives and practice nurses were aware of the reasons why pregnant women smoke as well as the health risks associated with smoking. All claimed to intervene by asking if their patients smoked. Most respondents claimed to record smoking status on health records and to give cessation advice to their patients. However, fewer of the health professionals provided advice to partners of women in their care and only a minority had read the NICE clinical guidelines on nicotine replacement therapies. There were limitations to the health professionals’ attitudes, knowledge and practice that could affect the quality of smoking cessation service offered to patients. Further training in evidence-based practice is required.

The effect of population-based health needs assessment on health visitor practice

This paper reports on a study examining the effects of undertaking population-based health needs assessment (HNA) on the knowledge, views and working practices of health visitors. Data were generated through indepth interviews with health visitors who had all utilized a standard mechanism for needs assessment. This was analysed to assess the impact of this work on the research respondents’ knowledge base, their attitudes and approaches to health visiting and their everyday practice. Findings suggest that undertaking health needs assessment increased understanding of public health concepts, enabled a profound reflection on current working practices and increased respondent’s desire to practise differently. However, despite these forces for change, the practitioners in this study found it very difficult to refocus their work in the way they desired due to a combination of inhibiting factors, including custom and practice and the perceptions and demands of others. If health visitors are to expand the scope of their work to incorporate an increased amount of community based activity as the UK Government is proposing, this study would suggest that these inhibiting factors must be addressed not only by health visitors themselves, but also by their employers and other primary care professionals.

Empowerment or control? An analysis of the extent to which client participation is enabled during health visitor/client interactions using a structured health needs assessment tool

The demand for explicitness in the way health visitors target their services has given rise to a plethora of different health needs assessment tools (HNATs). This paper describes an in-depth conversational analysis of the use in practice of these structured health needs assessment tools (HNATs) in two different NHS Community Trusts in England. These HNATs aimed to enable clients to participate in the assessment of their own health needs, as well as fulfilling the political requirements of justifying the expenditure of health visitor time where needs are identified. However, conversational analysis of 10 interactions showed that use of the instruments was associated with a failure to either identify needs that are relevant to the client or to enable clients to participate in the process. Use of the structured instrument simultaneously emphasises the significance of a professional lead, instead of client participation, and minimises the importance of inter-personal relationships and communication. In one site, a directly controlling style was apparent in the practice of health visitors who were, themselves, explicitly controlled by their managers. In the other site, professional expertise was emphasised, and a covert assessment style acted to disempower clients. The controlling nature of the interactions, the number of missed cues and the possibility of distress caused by the insensitivity of questioning style are all potentially harmful side effects of using structured instruments to assess needs. The problems seem to stem from the use of a pre-determined list of questions that form the basis for assuming that any family's health promotion needs can be categorised and predicted in advance. In conclusion, therefore, it is recommended that health visitors should use the open, conversational style of needs assessment that has been shown to be effective and acceptable, rather than an approach based on a structured instrument.

The treatment of postnatal depression by health visitors: impact of brief training on skills and clinical practice

Background: Postnatal depression can be effectively treated by cognitive behavioural counselling (CBC), a simple intervention designed to be delivered by non-specialists in mental health. Methods: Health visitors were trained in CBC and post-training changes in counselling skills, clinical practice and costs were assessed. Results: Following training health visitors showed improved counselling skills, and they carried out more mental health assessments, recorded mental symptoms more often and treated more women themselves. However, their mean number of contacts with depressed women did not change; and the number of urgent contacts diminished. Referrals to general practitioners did not increase but there was an increase in referrals to mental health services. Costs to health visitor practice did not increase. Limitations: Assessment of clinical practice was based on health visitor records. The study uses a ‘before and after’ design rather than randomisation of subjects. Conclusions: Training health visitors in CBC leads to improved counselling skills and corresponding changes in clinical practice, without increasing the costs of health visitor practice.

Social profile, maternal depression and welfare concerns in clients of health visitors and social workers: a comparative study

Research into the practice of health visitors and child care social workers with depressed mothers is limited. This is surprising in view of the known relationship between motherhood and depression, and the association also between child care problems and maternal depression. The study described below is the first which seeks to compare health visitor and child care social work clients/service users in relation to the issue of maternal depression. In particular, it seeks to compare the extent to which maternal depression is a feature of the work of social workers and health visitors, the relationship between maternal depression and the social composition of different client groups, the relationship between maternal depression and welfare concerns—particularly child abuse—and the extent to which such concerns lead to referral from health visitors to social workers. The research shows: (1) interesting similarities between the depressed health visitor clients and social work clients as a whole; (2) the importance of low income and absence of support in the ‘progression’ from health visitor to social work clients status; and (3) an alarming emerging gap in services provided for severely disadvantaged families with child and family care problems.