Baby Box: evaluation

Appendix D – Topic guides for in-depth interviews

Parent interview topic guide

Introductions

Confirm background details from survey/warm up

Thank you very much for agreeing to take part. Before we start, I'd just like to confirm a couple of details about you (briefly – just checking details from survey):

• Who do you live with at the moment?
• And can I confirm you are still [working/on maternity leave/staying at home] at the moment?
• And your baby is [x] months old?

Registration / delivery (briefly – only probe if issues raised)

I want to start with a few questions about registering for and getting your baby box.

• Overall, how did you find the registration process? Probe on any issues raised.
• Who completed the registration form – was it you or your midwife? How did that work for you? Probe on any issues raised.
• How did you find the delivery process generally? Probe on any issues raised.

First impressions and general views on box and contents (again, briefly)

• Now thinking on to when you first received the box, what were your first impressions of the box when it arrived?
  • What were you expecting? Did it meet these expectations?
  • Views on quality of box and contents?
  • And range of contents?

Use of the baby box and its contents (briefly)

• Can you talk me through the different ways you and your family have used the baby box and its contents.
  • Who has used the box and its contents? Probe – you, your partner, your other children, grandparents etc.?
  • Have different people used particular items more/less? Why?
• (Priority Q) Which things have you found most useful?
  • Why?
  • How / when did you use it?
• (Priority Q) And which least useful/used? Why?
• Anything missing that you think is essential for a new baby?

What difference, if any, the baby box has made

• We're interested in what difference, if any, the baby box makes to families. What, if any, difference has the baby box and its contents made to you/your family? Probe fully:
  • Probe for details on any positives mentioned – e.g. which elements of the baby box/contents led to this, what exactly was the benefit for them, how did baby box/contents lead to this?
  • Any benefits you weren't expecting?
  • Probe on any negatives mentioned - e.g. what about the baby box box/contents led to this, how, and why?
  • Did you have any (other) concerns or problems with baby box or its contents? Probe on any mentioned.

Perceived impacts on play/talking/reading with child (priority section)

• Are there any items in the box you have used when playing with/talking to your baby? Which ones?
  • Probe – how and when did you use them? What difference, if any, did having these items from birth make to you and your baby? (anything they've done differently/sooner than they intended?)
• What do you think of the books?
• Have you read any of them with your baby? When did you start using them?
  • If not - Why/why not?
  • Do you think the books in the box encouraged you or your partner to read to your baby? (E.g. read more often or started at a younger age?)
• What do you think of the play mat?
• Have you used it yet? Why/why not?
• IF YES: what have you used it for? (e.g., play, somewhere comfortable to lie/sit baby down)
  • How often do you use it? (if used in past, probe on how did use it).
  • Where do you use the play mat? (Just at home/at friends/family/out and about?)
  • If use it for play: How do you use it for play? what kinds of play/activities do you use it for? Probes: does your baby enjoy playing with his/her toys on it? Do you and your baby play on it together? Had they already got/considered getting a play mat before they knew they would receive it in the box? What would you have used otherwise?
  • Has your partner or any other family member or carer used any of these items with your baby (Books, play mat, anything else mentioned)? What effect do you think this had? Probe.

Perceived impacts on attachment

• What do you think of the baby wrap?
• Do/did you or anyone else in your family use it? Who? How often? In what situations? For how long? Probe around whether in home /outside
  • Was a wrap something you had considered using before you received the Baby Box?
  • What difference, if any, did using the wrap make to you, your partner and your baby?
  • Did you find the instructions on how to use the wrap helpful? Did you get help from someone (a friend, partner, professional) on how to use it?
• If not used, probe around why and what might encourage them to use it? What did you or your partner do instead of using a carrier at home and when outdoors?

Perceived impacts on sleeping

You said in the survey you [have/haven't] use the box for sleeping, can I just check that's still correct?

If have used box for sleeping:

• Could you tell me a bit about how you've used the box for sleeping?
  • When (daytime naps, night time, etc.)? (If only use for specific times, probe on why)
  • Where (i.e. where in their house and/or at others – e.g. Grandparents)? (if only use in specific places, probe on why)
  • How long did they use the box for sleeping for (i.e. at what age did they stop using for sleeping, if stopped using)?
  • How useful did you find it as a sleeping space? Advantages/disadvantages?
  • Do they have other sleep spaces too?
  • Where would your baby sleep/have slept (for types of sleeps/locations mentioned) if you did not have a Baby Box?
  • What difference did the box itself make to you? (explore the impact on their behaviour / what they did around sleep – e.g. did they use it instead of buying something else, use for specific times/places like naps, etc.)

If haven't used for sleeping:

• Why have you not used it? Probe fully.
  • How would they feel about using it for sleeping? Probe fully.
• Where does your baby sleep? (during the day, at night)
• Do you use the box for anything else? What?

ALL

• Any suggestions for improvements to the box itself?

Perceived impacts: Learning (priority section)

• Do you feel you've learned anything from getting a baby box?
  • For anything mentioned –
    • What specifically did you learn?
    • What part of the baby box helped you with this? (from leaflet, from other contents, from parent club)?
    • Priority questions: What action, if any, did you take after learning this? What effect, if any, do you think this had for you or your baby?
    • NB depending on what they mention in response to general question on learning above, may not need to probe in detail on every leaflet.
    • Now thinking specifically about the leaflets included in the box
  • Did you find any of them helpful?
    • Which ones? (prompt if necessary: breastfeeding, safe sleeping, post-natal depression and anxiety, sources of advice and support)
    • How were they helpful? What specifically did you learn/take from them?
      • Any leaflets prompting discussions with family/friends/professionals?
      • Probe fully – any actions taken / things done differently as result of reading them? (e.g. different approaches to parenting, taking up services, etc.) What effect did those actions have?
  • Probe specifically on safe sleeping leaflet if not already mentioned – did they read it? What, if anything, did they take from it (even if not using box for sleeping)? Anything you didn't already know? Did you follow this when settling your baby to sleep?
• Was there any information that you feel was missing in the box?
• Have you signed up for the Parent Club emails?
  • If yes – do you read? Why/why not? If read - what do you think of them? Have you got anything helpful from them? What? What action have you taken as a result? Any changes you have made to the way you care for your baby since reading the emails?
  • Any suggestions for improvement / additional topics of interest / things you'd like to know more about?
  • If not, what, if anything, might encourage you to sign up? Where do you tend to go if you want advice/info about parenting?

Perceived impacts: engagement with health professionals

• NB if already discussed things they've talked to health professionals about, you only need to follow up here on anything else they may not have mentioned.
• Have you discussed the box or its contents with any health professionals, as far as you can remember? Could you tell me a bit more about that?
  • Which ones? Midwife or Health Visitor?
  • When? When registered or later on home visits/other appointments?
  • What did you discuss? Was the discussion helpful?
  • What, if anything, did this conversation lead to (e.g. additional support/referral – was this taken up / sustained?)?

Perceived impacts: Financial

• You said in the survey that you think the box [did/didn't] save you money? Would you still agree with that? Could you say a little more about that?
  • If did save them money, how did this benefit them? Did they use the money on other things? What? Who for? (baby, self, wider family?)
• Can you think of anything in the box that you probably would not have bought otherwise?
  • Do you use those things or not? Why/why not?
• Did getting the baby box prompt you to buy anything else? E.g. could be something in box that they found useful and decided to buy more of or a bigger size
• Do you think you would have had the things you needed for your baby's first 6 months if you had not received the box?

Views on universal availability of the box

• How did you feel about being offered for the Baby Box?
• Probe if necessary: Pleased/indifferent/surprised?
• When you first heard about it, were you keen to register for it, or did you have any reservations? Why? What were they?
• The baby box is offered to every baby in Scotland, regardless of how many children they already have or what their income is. How do you feel about that? PROBE: Positive/negative? Why?
  • If think it should be means tested/only for first parents etc.: Why do you think that? What advantages do you think that would have? What do you think are the disadvantages of the universal approach as it stands?
  • If think should be universal: Why do you think that? What advantages do you think that has? Do you think there are any disadvantages to this approach?

Suggestions for change/improvement

• Finally, before we finish, I'd just like to ask for any other suggestions you might not have already mentioned for improving the box, its contents, or the process for registering/receiving it.
• If have discussed benefits: If you had to pick one thing, what would you say is the main benefit of the baby box for you?

Thank, sign incentive form, and close

Health Visitor, midwife and family nurse interview topic guide

Introductions

Confirm background details from survey/warm up.

Thank you very much for agreeing to take part. Before we start, I'd just like to confirm a couple of details about you (briefly – just checking details from survey):

• Please can I confirm your role? (health visitor/midwife/family nurse)
• And how long you've been in this role?
• And do you work full time or part time? If part time: And how many hours per week are you contracted to work?

Purpose of the Baby Box

Thanks very much. I'd like to start by asking…

• How you would describe the purpose of the Baby Box Scheme? Probe fully (priority q)
• And to what extent do you think that it is fulfilling this purpose? Why/Why not?

Your role in relation to the Baby Box

And now moving on to talk about your role in relation to the Baby Box.

• First of all, what is your role in relation to the Baby Box? Probe fully
• How do you feel about your role? Are you clear about it? Why/why not?
• If not already mentioned: And as part of your role, do you discuss the contents and purpose of the Baby Box with parents?
• If yes: How confident do you feel in discussing…?
• The contents of the Box? Why/Why not? How familiar do you feel you are with the Box contents? (priority q) What would make you feel more confident? Probe fully
• The purpose of the Box? Why/Why not? (priority q) What would make you feel more confident?
• If no: How familiar do you feel you are with the Box contents?
• Who would usually discuss the contents and purpose of the Box with new parents, in your experience?
• Do you feel the Baby Box is relevant to your role? Why/why not?
• Can you think of any benefits of you being more involved with the Baby Box scheme?

Registration and delivery of the Box (inc. cancellation of deliveries)

And moving on now to discuss the [midwives only: registration and] delivery of the Baby Box…

• Midwives only: How does the process normally work? Do you tend to complete the registration form together with the mother or give it to the mother to complete and post back? Probe for reasons for approach used
• How well, or not, do you think the process for registering for the Baby Box is working? Probe on any positives/ issues raised
• If give to mother to post: do you know if this has caused any issues? For example mothers losing the form/forgetting to post it?

Ask all

• How well, or not, do you think the delivery process is working? Probe on any positives/ issues raised
  • Do parents ever come to you with problems related to the delivery of their Box?
  • If yes: What are the nature of these issues? Probe fully
  • And how confident do/would you feel to handle complaints about Box delivery?
  • What could help you be clearer on this process? Probe fully.
  • Midwives and FN only: And how clear or unclear are you on the process for cancelling the delivery of a Baby Box in the event of a bereavement? Why do you say that?

Perceptions of usefulness of the Box contents

Now moving on to your views on the box contents

• All: Which items do you think are most useful to include in the Box? Why?
• And which things do you think are least useful? Why?
• Is there anything missing from the Box that you think is essential for a new baby? Either contents or information leaflets. Why these items or leaflets? Probe fully For example, think they are essential, parents have mentioned these items would be useful, etc.

Perceived impacts of the scheme: On families

• What, if any, would you say have been the main impacts, positive or negative, of the Baby Box for families?
  • Probe for details on any positives mentioned – e.g. which elements of the baby box/contents led to this? How, and why?
  • Any unexpected benefits? Any unexpected concerns or issues?
  • Probe on any negatives mentioned - e.g. which elements of the baby box box/contents led to this, how, and why?
• If not already mentioned: Do you think the Baby Box has increased parents' understanding of risky and positive parenting behaviours? Can give examples of breastfeeding and safe sleeping if needed
• If yes: how has it done this? Probe for behaviour not just understanding
• If no: what do you think could help with this?
• And how effective or ineffective do you think the Baby Box is in ensuring all families in Scotland have access to newborn essentials? Probe fully Why do you say this?

Percieved impacts of the scheme: Engagement between parents and health professionals

Interviewer note: bear in mind differences in responses between HVs and midwives in the survey. Looking to explore reasons for this.

• Do you feel the Baby Box has helped you to engage with parents at all?
  • If yes - In what ways? What aspects of the Baby Box have helped you to engage with parents? Probe fully (triggering discussion of specific issues, opportunities to ask questions/provide advice, etc)
  • Any groups of parents you feel it has helped you engage with more than others?
  • What difference do you think that has made? Probe fully for details – prompt if necessary to relationship you have with parents, to willingness of parents to discuss risky behaviours, etc.
• If no: Can you see any ways in which the Baby Box might be able to support you to engage with parents?
  • What gets in the way of this (barriers to engagement)?
• (Use flexibly – if not sure how to answer, skip this section) What about other health professionals? As far as you are aware, has the Baby Box scheme encouraged parents to engage with other health professionals, or helped them to engage with parents? In what ways?
  • If yes: Any groups of health professionals/any groups of parents in particular? Any particular settings?
  • In what ways? What aspects of the Box? What difference did this make?
• If no: Can you think of any ways in which the Baby Box might be able to support health professionals to engage with parents?
  • For any groups of health professionals/any groups of parents in particular? Any particular settings?
  • What gets in the way of this (barriers to engagement)?
• If not already mentioned:
  • Have you (or parents?) used the Box as a prompt to start discussions with parents about safe sleeping in the box or more generally? Probe fully
  • Have you provided any advice on safe sleeping in the box? How comfortable do you feel discussing safe sleeping in the box with parents?
  • Have you used items designed to encourage attachment (books, playmat, baby wrap) as prompts to have discussions with parents about attachment /interacting with their baby? Or anything else? Probe fully
  • Have you (or parents) used the information leaflets in the box as prompts to have discussions with parents on these topics? (prompt if necessary: breastfeeding, safe sleeping, post-natal depression and anxiety, sources of advice and support)? Probe fully– can you tell me a bit about that (what action was taken, what impact did they have etc)
• And thinking about parents' engagement with wider services (e.g. other health services, breastfeeding advice, parent and baby groups, etc.). Has the Baby Box had any impact on this? Has it helped you to engage parents with other services?
  • If yes: What kind of services?
  • How has it done this?
  • And have parents remained engaged with these services, as far as you know?
  • If no: can you think of any ways in which it might be able to do this?
• And thinking specifically about families who are less likely to engage with services. Has the Baby Box helped you to identify families who are unlikely to engage with services?
  • If yes: How has it done this?
  • If no: can you think of any ways in which the BB could help health workers to identify and engage with hard to reach families?

Training on the scheme (Priority section)

And thinking now about training on the Baby Box scheme…

• Have you received any training on the Baby Box scheme?
  • If yes: What did this involve? Probe fully
  • Do you feel this training was sufficient? Why/why not?
  • What additional training or information on the Box would you like to receive, if any? How would you like to receive this? For example, informal discussions with colleagues, leaflets, formal training online or face to face.
  • If no: Do you feel that you would have benefited from training on the BB? Why? Why not? PROBE FULLY For example, ability to talk confidently with parents about the purpose of the Box, familiarity with Box contents
  • What training or information on the Box would you like to recieve? How would you like to recieve this? For example, informal discussions with colleagues, leaflets, formal training online or face to face.

Suggestions for change/improvement

• Finally, before we finish, I'd just like to ask for any other suggestions you might not have already mentioned for improving the box, its contents, or the process for registering/receiving it.
• If you had to pick one thing, what would you say is the main benefit of the baby box for parents?

Midwife / health visitors interview topic guide

Introductions

Confirm background details from survey/warm up.

Thank you very much for agreeing to take part. Before we start, I'd just like to confirm a couple of details about you (briefly – just checking details from survey):

• Please can I confirm your role? (health visitor/midwife/family nurse)
• And how long you've been in this role?
• And do you work full time or part time? If part time: And how many hours per week are you contracted to work?

Purpose of the Baby Box

Thanks very much. I'd like to start by asking…

• How you would describe the purpose of the Baby Box Scheme? Probe fully (priority q)
• And to what extent do you think that it is fulfilling this purpose? Why/Why not?

Your role in relation to the Baby Box

And now moving on to talk about your role in relation to the Baby Box.

• First of all, what is your role in relation to the Baby Box? Probe fully
• How do you feel about your role? Are you clear about it? Why/why not?
• If not already mentioned: And as part of your role, do you discuss the contents and purpose of the Baby Box with parents?
• If yes: How confident do you feel in discussing…?
• The contents of the Box? Why/Why not? How familiar do you feel you are with the Box contents? (priority q) What would make you feel more confident? Probe fully
• The purpose of the Box? Why/Why not? (Priority q) What would make you feel more confident?
• If no: How familiar do you feel you are with the Box contents?
• Who would usually discuss the contents and purpose of the Box with new parents, in your experience?
• Do you feel the Baby Box is relevant to your role? Why/why not?
• Can you think of any benefits of you being more involved with the Baby Box scheme?

Registration and delivery of the Box (inc. cancellation of deliveries)

And moving on now to discuss the [midwives only: registration and] delivery of the Baby Box…

• Midwives only: How does the process normally work? Do you tend to complete the registration form together with the mother or give it to the mother to complete and post back? Probe for reasons for approach used
• How well, or not, do you think the process for registering for the Baby Box is working? Probe on any positives/ issues raised
• If give to mother to post: do you know if this has caused any issues? For example mothers losing the form/forgetting to post it?

Ask all

• How well, or not, do you think the delivery process is working? Probe on any positives/ issues raised
• Do parents ever come to you with problems related to the delivery of their Box?
• If yes: What are the nature of these issues? Probe fully
• And how confident do/would you feel to handle complaints about Box delivery?
• What could help you be clearer on this process? Probe fully.
• Midwives and fn only: And how clear or unclear are you on the process for cancelling the delivery of a Baby Box in the event of a bereavement? Why do you say that?

Perceptions of usefulness of the Box contents

Now moving on to your views on the box contents

• All: Which items do you think are most useful to include in the Box? Why?
• And which things do you think are least useful? Why?
• Is there anything missing from the Box that you think is essential for a new baby? Either contents or information leaflets. Why these items or leaflets? Probe fully For example, think they are essential, parents have mentioned these items would be useful, etc.

Perceived impacts of the scheme: On families

• What, if any, would you say have been the main impacts, positive or negative, of the Baby Box for families?
  • Probe for details on any positives mentioned – e.g. which elements of the baby box/contents led to this? How, and why?
  • Any unexpected benefits? Any unexpected concerns or issues?
  • Probe on any negatives mentioned - e.g. which elements of the baby box box/contents led to this, how, and why?
• If not already mentioned: Do you think the Baby Box has increased parents' understanding of risky and positive parenting behaviours? Can give examples of breastfeeding and safe sleeping if needed
• If yes: how has it done this? Probe for behaviour not just understanding
• If no: what do you think could help with this?
• And how effective or ineffective do you think the Baby Box is in ensuring all families in Scotland have access to newborn essentials? Probe fully Why do you say this?

Percieved impacts of the scheme: Engagement between parents and health professionals

Interviewer note: bear in mind differences in responses between HVs and midwives in the survey. Looking to explore reasons for this.

• Do you feel the Baby Box has helped you to engage with parents at all?
• If yes - In what ways? What aspects of the Baby Box have helped you to engage with parents? Probe fully (triggering discussion of specific issues, opportunities to ask questions/provide advice, etc)
  • Any groups of parents you feel it has helped you engage with more than others?
  • What difference do you think that has made? Probe fully for details – prompt if necessary to relationship you have with parents, to willingness of parents to discuss risky behaviours, etc.
• If no: Can you see any ways in which the Baby Box might be able to support you to engage with parents?
  • What gets in the way of this (barriers to engagement)?
• (Use flexibly – if not sure how to answer, skip this section) What about other health professionals? As far as you are aware, has the Baby Box scheme encouraged parents to engage with other health professionals, or helped them to engage with parents? In what ways?
  • If yes: Any groups of health professionals/any groups of parents in particular? Any particular settings?
  • In what ways? What aspects of the Box? What difference did this make?
• If no: Can you think of any ways in which the Baby Box might be able to support health professionals to engage with parents?
  • For any groups of health professionals/any groups of parents in particular? Any particular settings?
  • What gets in the way of this (barriers to engagement)?
  • If not already mentioned:
  • Have you (or parents?) used the Box as a prompt to start discussions with parents about safe sleeping in the box or more generally? Probe fully
  • Have you provided any advice on safe sleeping in the box? How comfortable do you feel discussing safe sleeping in the box with parents?
  • Have you used items designed to encourage attachment (books, playmat, baby wrap) as prompts to have discussions with parents about attachment /interacting with their baby? Or anything else? Probe fully
  • Have you (or parents) used the information leaflets in the box as prompts to have discussions with parents on these topics? (prompt if necessary: breastfeeding, safe sleeping, post-natal depression and anxiety, sources of advice and support)? Probe fully– can you tell me a bit about that (what action was taken, what impact did they have etc)
• And thinking about parents' engagement with wider services (e.g. other health services, breastfeeding advice, parent and baby groups, etc.). Has the Baby Box had any impact on this? Has it helped you to engage parents with other services?
  • If yes: What kind of services?
  • How has it done this?
  • And have parents remained engaged with these services, as far as you know?
  • If no: can you think of any ways in which it might be able to do this?
• And thinking specifically about families who are less likely to engage with services. Has the Baby Box helped you to identify families who are unlikely to engage with services?
  • If yes: How has it done this?
  • If no: can you think of any ways in which the BB could help health workers to identify and engage with hard to reach families?

Training on the scheme (Priority section)

And thinking now about training on the Baby Box scheme…

• Have you received any training on the Baby Box scheme?
  • If yes: What did this involve? Probe fully
  • Do you feel this training was sufficient? Why/why not?
  • What additional training or information on the Box would you like to receive, if any? How would you like to receive this? For example, informal discussions with colleagues, leaflets, formal training online or face to face.
  • If no: Do you feel that you would have benefited from training on the BB? Why? Why not? Probe fully For example, ability to talk confidently with parents about the purpose of the Box, familiarity with Box contents
  • What training or information on the Box would you like to receive? How would you like to receive this? For example, informal discussions with colleagues, leaflets, formal training online or face to face.

Suggestions for change/improvement

• Finally, before we finish, I'd just like to ask for any other suggestions you might not have already mentioned for improving the box, its contents, or the process for registering/receiving it.
• If you had to pick one thing, what would you say is the main benefit of the baby box for parents?

Thank and close